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. 2023 Jul 21:13:04060.
doi: 10.7189/jogh.13.04060.

Antibiotic resistance trends for common bacterial aetiologies of childhood diarrhoea in low- and middle-income countries: A systematic review

Raghavee Neupane  1 , Myra Bhathena  1 , Gopika Das  1 , Elizabeth Long  1 , Jennifer Beard  1 , Hiwote Solomon  1 , Jon L Simon  2 , Yasir B Nisar  2 , William B MacLeod  1 , Davidson H Hamer  1   3   4   5   6
Affiliations

Antibiotic resistance trends for common bacterial aetiologies of childhood diarrhoea in low- and middle-income countries: A systematic review

Raghavee Neupane et al. J Glob Health. .

Abstract

Background: Diarrhoea is the second most common cause of death among children under the age of five worldwide. The World Health Organization (WHO) recommends treating diarrhoea with oral rehydration therapy, intravenous fluids for severe dehydration, and zinc supplements. Antibiotics are only recommended to treat acute, invasive diarrhoea. Rising antibiotic resistance has led to a decrease in the effectiveness of treatments for diarrhoea.

Methods: A systematic literature review in PubMed, Web of Science, and EMBASE was conducted to identify articles relevant to antibiotic-resistant childhood diarrhoea. Articles in English published between 1990 to 2020 that described antibiotic resistance patterns of common pathogens causing childhood diarrhoea in low- and middle-income countries were included. The studies were limited to papers that categorized children as 0-5 years or 0-10 years old. The proportion of isolates with resistance to major classes of antibiotics stratified by major WHO global regions and time was determined.

Results: Quantitative data were extracted from 44 articles that met screening criteria; most focused on children under five years. Escherichia coli isolates had relatively high resistance rates to ampicillin and tetracycline in the African (AFR), American (AMR), and Eastern Mediterranean Regions (EMR). There was moderate to high resistance to ampicillin and third generation cephalosporins among Salmonella spp in the AFR, EMR, and the Western Pacific Region (WPR). Resistance rates for ampicillin, co-trimoxazole, and chloramphenicol for Shigella in the AFR started at an alarmingly high rate ( ~ 90%) in 2006 and fluctuated over time. There were limited antibiotic resistance data for Aeromonas, Yersinia, and V. cholerae. The 161 isolates of Campylobacter analysed showed initially low rates of fluoroquinolone resistance with high rates of resistance in recent years, especially in the Southeast Asian Region.

Conclusions: Resistance to inexpensive antibiotics for treatment of invasive diarrhoea in children under ten years is widespread (although data on 6- to 10-year-old children are limited), and resistance rates to fluoroquinolones and later-generation cephalosporins are increasing. A strong regional surveillance system is needed to carefully monitor trends in antibiotic resistance, future studies should include school-aged children, and interventions are needed to reduce inappropriate use of antibiotics for the treatment of community-acquired, non-invasive diarrhoea.

Registration: This systematic review was registered in Prospero (registration number CRD42020204004) in August 2020.

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Conflict of interest statement

Disclosure of interest: The authors have completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests.

Figures

Figure 1
Figure 1
PRISMA flow diagram of article extraction for systematic review of antimicrobial resistance (AMR) in childhood diarrhoea in low- and middle-income countries (LMIC) [11].
Figure 2
Figure 2
Antibiotic resistance among Escherichia coli isolates in the African Region (AFR) by time period. The number of isolates tested for time period and number of studies are shown below the relevant time period.
Figure 3
Figure 3
Antibiotic resistance among Escherichia coli isolates in the American Region (AMR) by time period. The number of isolates tested for time period and number of studies are shown below the relevant time period.
Figure 4
Figure 4
Antibiotic resistance among Escherichia coli isolates in the Eastern Mediterranean Region (EMR) by time period. The number of isolates tested for time period and number of studies are shown below the relevant time period.
Figure 5
Figure 5
Antibiotic resistance among Salmonella isolates in the African Region (AFR) by time period. The number of isolates tested for time period and number of studies are shown below the relevant time period.
Figure 6
Figure 6
Antibiotic resistance among Salmonella isolates in the Eastern Mediterranean Region (EMR) by time period. The number of isolates tested for time period and number of studies are shown below the relevant time period.
Figure 7
Figure 7
Antibiotic resistance among Salmonella isolates in the Western Pacific Region (WPR) by time period. The number of isolates tested for time period and number of studies are shown below the relevant time period.
Figure 8
Figure 8
Antibiotic resistance among Shigella isolates in the African Region (AFR) by time period. The number of isolates tested for time period and number of studies are shown below the relevant time period.
Figure 9
Figure 9
Antibiotic resistance among Shigella isolates in the Eastern Mediterranean Region (EMR) by time period. The number of isolates tested for time period and number of studies are shown below the relevant time period.
Figure 10
Figure 10
Antibiotic resistance among Shigella isolates in the South-East Asian Region (SEAR) by time period. The number of isolates tested for time period and number of studies are shown below the relevant time period.
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References

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