ArticlePloS one2020
Antimicrobial resistance associations with national primary care antibiotic stewardship policy: Primary care-based, multilevel analytic study.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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Who cites it
25 citing papers in PubMed, 34 citations in OpenAlex.
- Exploring the in situ evolution of nitrofurantoin resistance in clinically derived uropathogenic Escherichia coli isolates.The Journal of antimicrobial chemotherapy · 2023Trial
- Prevalence of antimicrobial resistance in acute community-acquired urinary tract infections in Sub-Saharan Africa: a systematic review.JAC-antimicrobial resistance · 2026Review
- Social determinants of health and antimicrobial resistance in the UK: a scoping review.BMJ open · 2026Article
- Doctor-related Knowledge, Attitudes and Practices (KAP) factors influencing antibiotic prescribing for urinary tract infections in primary care in Singapore: a cross-sectional study.BMC primary care · 2026Article
- The Association Between Antibiotic Use and the Incidence of Third-Generation Cephalosporin-Resistance inAntibiotics (Basel, Switzerland) · 2026Article
- Implementing a multimodal antimicrobial stewardship programme in primary care in Kosova-a protocol for implementation and evaluation.Implementation science communications · 2025Article
- Dynamic association of antimicrobial resistance in urinary isolates ofThe Lancet regional health. Europe · 2025Article
- Review
- Nitrofurantoin as a preferred first-line therapy for urinary tract infection: A comparison using urinary tract infection-specific antibiograms.Bladder (San Francisco, Calif.) · 2025Article
- Antibiotic Resistance of Urinary Tract Infection Recurrences in a Large Integrated US Healthcare System.The Journal of infectious diseases · 2024Article
- Predicting future hospital antimicrobial resistance prevalence using machine learning.Communications medicine · 2024Article
- A Bayesian Model Based on Local Phenotypic Resistance Data to Inform Empiric Antibiotic Escalation Decisions.Infectious diseases and therapy · 2024Article
- Antimicrobial use and combination of resistance phenotypes in bacteraemic Escherichia coli in primary care: a study based on Japanese national data in 2018.The Journal of antimicrobial chemotherapy · 2024Article
- Effects of a Primary Care Antimicrobial Stewardship Program on Meticillin-ResistantAntibiotics (Basel, Switzerland) · 2024Article
- Long term nitrofurantoin induced interstitial lung disease: a case series and literature review.Sarcoidosis, vasculitis, and diffuse lung diseases : official journal of WASOG · 2023Article
- One health transmission of fluoroquinolone-resistantOne health (Amsterdam, Netherlands) · 2023Article
- Nitrofurantoin resistance as an indicator for multidrug resistance: an assessment ofJAC-antimicrobial resistance · 2023Article
- Impact of an Antimicrobial Stewardship Strategy on Surgical Hospital Discharge: Improving Antibiotic Prescription in the Transition of Care.Antibiotics (Basel, Switzerland) · 2023Article
- Impact of a Primary Care Antimicrobial Stewardship Program on Bacterial Resistance Control and Ecological Imprint in Urinary Tract Infections.Antibiotics (Basel, Switzerland) · 2022Article
- Myths and Misconceptions around Antibiotic Resistance: Time to Get Rid of Them.Infection & chemotherapy · 2022Review
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRecent UK antibiotic stewardship policies have resulted in significant changes in primary care dispensing, but whether this has impacted antimicrobial resistance is unknown.
aimTo evaluate associations between changes in primary care dispensing and antimicrobial resistance in community-acquired urinary Escherichia coli infections.
methodsMultilevel logistic regression modelling investigating relationships between primary care practice level antibiotic dispensing for approximately 1.5 million patients in South West England and resistance in 152,704 community-acquired urinary E. coli between 2013 and 2016. Relationships presented for within and subsequent quarter drug-bug pairs, adjusted for patient age, deprivation, and rurality.
resultsIn line with national trends, overall antibiotic dispensing per 1000 registered patients fell 11%. Amoxicillin fell 14%, cefalexin 20%, ciprofloxacin 24%, co-amoxiclav 49% and trimethoprim 8%. Nitrofurantoin increased 7%. Antibiotic reductions were associated with reduced within quarter same-antibiotic resistance to: amoxicillin, ciprofloxacin and trimethoprim. Subsequent quarter reduced resistance was observed for trimethoprim and amoxicillin. Antibiotic dispensing reductions were associated with increased within and subsequent quarter resistance to cefalexin and co-amoxiclav. Increased nitrofurantoin dispensing was associated with reduced within and subsequent quarter trimethoprim resistance without affecting nitrofurantoin resistance.
conclusionsThis evaluation of a national primary care stewardship policy on antimicrobial resistance in the community suggests both hoped-for benefits and unexpected harms. Some increase in resistance to cefalexin and co-amoxiclav could result from residual confounding. Randomised controlled trials are urgently required to investigate causality.
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