Cystisis and resistance 2022 study

E. coli resistance rates over the years according to the antibiotic used are presented below:

Discussion

Limitations of the study

For NOR antibiotics: Norfloxacin, we only have results for the first three years of the study. Ketterthill used VITEK cards from Biomérieux for the antibiotic susceptibility testing. Ketterhill has stated that these cards contain a number of antibiotics, and when the cards are updated, some antibiotics are replaced by others, depending on their therapeutic value. This explains why some antibiotics are tested more systematically.

In the raw data, the prescriber did not specify the reason for prescribing for the prescribed test.

Nor did the prescriber indicate the history of the patient.

As the number of samples from men was much lower, we did not focus on any specific interpretation (on average less than 2/1000).

In terms of macroscopic data, the method used to collect the samples does not allow any conclusions to be drawn about the potential impact of the pandemic.

For each antibiotic, no information is available on the previous dosage regimens used in clinical practice.

Assumption

In the first study, Dr Camara-Sampil had assumed that the global pandemic announced by the WHO on 11 March 2020 may have had impact on the resistance rate of some antibiotics, due to lower prescription rates. However, the findings from the two studies did not confirm this assumption.

In addition, the pandemic did not appear to have a significant impact on the annual number of samples.

Conclusion

In the previous study, Dr Camara-Sampil expressed doubts about the efficacy of Fosfomycin and Nitrofurantoin in the treatment of cystitis. He had observed that many women attending his surgery with recurrent symptoms after treatment with fosfomycin or nitrofurantoin.

Both nitrofurantoin and fosfomycin have a very low rate of resistance to E. coli (around 1.5%) compared to the other antibiotics in this study, and these results were very similar to those reported in the previous study (antibiotic cystitis and resistance- study 1). Thus, these two antibiotics remain a valid option for first-line antibiotic treatment of cystitis.

Two comments can be made from this observation:

It is possible that the inefficacy of the first-line antibiotic was reported too early, while the second antibiotic was prescribed too early. There is a risk of diminishing the effects of the second-line antibiotic by prescribing it too early. This raises the question of the efficacy of a single dose in the case of Fosfomycin. A Chinses study published in 2013 showed that three doses over a 5-day period, at 48-hour intervals, was an effective dosage regimen. Data from this Chinese study are encouraging, particularly in terms of side effects which were very rare and mild (mainly digestive disorders). Fosfomycin, which has a very low rate of resistance to E. coli, offers anoptimal therapeutic option.