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Antibiotic-induced changes in the human gut microbiota for the most commonly prescribed antibiotics in primary care in the UK: a systematic review.

ABSTRACT: OBJECTIVE:The gut microbiota influences many aspects of human health. We investigated the magnitude and duration of changes in gut microbiota in response to antibiotics commonly prescribed in UK primary care. METHODS:We searched MEDLINE, EMBASE and AMED, all years up to May 2020 including all study designs, collecting and analysing data on the effect of antibiotics prescribed for respiratory and urinary tract infections. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane standard methods. Risk of bias was evaluated using the Critical Appraisal Skills Programme. Narrative synthesis was used to report the themes emerging from the data. MAIN OUTCOME MEASURES:Primary outcomes were antibiotic-induced changes in the composition and/or diversity of the gut microbiota. Secondary outcome was the time for the microbiota to return to baseline. RESULTS:Thirty-one articles with low or unclear risk of bias showed that antibiotics impact the gut microbiota by causing rapid and diminished levels of bacterial diversity and changes in relative abundances. After cessation of treatment, gut bacteria recover, in most individuals, to their baseline state within a few weeks. Some studies suggested longer term effects from 2 to 6?months. Considerable heterogeneity in methodology makes the studies prone to biases and other confounding factors. Doxycycline was associated with a marked short-term decrease in Bifidobacterium diversity. Clarithromycin decreased the populations of Enterobacteria, and the anaerobic bacteria Bifidobacterium sp and Lactobacillus sp in numbers and diversity for up to 5 weeks. Phenoxymethylpenicillin, nitrofurantoin and amoxicillin had very little effect on the gut microbiome. CONCLUSIONS:Despite substantial heterogeneity of the studies and small sample sizes, there is evidence that antibiotics commonly used in primary care influence the composition of the gastrointestinal microbiota. Larger population-based studies are needed to fully understand how antibiotics modulate the microbiota, and to determine if these are associated with (longer term) health consequences. PROSPERO REGISTRATION NUMBER:CRD42017073750.

SUBMITTER: Elvers KT

PROVIDER: S-EPMC7507860 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Antibiotic-induced changes in the human gut microbiota for the most commonly prescribed antibiotics in primary care in the UK: a systematic review.

Elvers Karen T KT Wilson Victoria J VJ Hammond Ashley A Duncan Lorna L Huntley Alyson L AL Hay Alastair D AD van der Werf Esther T ET

BMJ open 20200921 9

<h4>Objective</h4>The gut microbiota influences many aspects of human health. We investigated the magnitude and duration of changes in gut microbiota in response to antibiotics commonly prescribed in UK primary care.<h4>Methods</h4>We searched MEDLINE, EMBASE and AMED, all years up to May 2020 including all study designs, collecting and analysing data on the effect of antibiotics prescribed for respiratory and urinary tract infections. We followed the Preferred Reporting Items for Systematic Rev ...[more]

PMID: 32958481

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Project description:BackgroundIn most low-income countries, febrile-pediatric-cases are often treated empirically with accessible antibiotics without periodic epidemiological surveillance, susceptibility testing, or minimal lethal dose calculations. With this backdrop, the study was undertaken to evaluate the susceptibility trend of Salmonella enterica against the commonly prescribed antibiotics.MethodsAll isolates of Salmonella enterica were identified by standard protocols of biotyping and serotyping, then tested against antibiotics by the modified Kirby disk-diffusion method. Minimum Inhibitory Concentration (MIC) of isolates was determined by the agar-dilution method and compared with disk diffusion results and on nalidixic-acid sensitive/resistant strains.ResultsAmong 1815 febrile-pediatric patients, 90(4.9%) isolates of Salmonella enterica [serovar: Salmonella Typhi 62(68.8%) and Salmonella Paratyphi A 28(31.1%)] were recovered. The incidence of infection was higher among males, age groups 5 to 9, and patients enrolling in the out-patient department (OPD). On the disk-diffusion test, most isolates were sensitive against first-line drugs i.e.cephalosporins, and macrolides. However, against quinolones, a huge percentile 93.3%, of isolates were resistant [including 58 Typhiand 26 Paratyphiserovar] while nearly 14% were resistant against fluoroquinolones. When MICs breakpoint were adjusted as follows: 4 μg/ml for azithromycin, ≥1 μg/ml for ciprofloxacin, 2 μg/ml for ofloxacin, 8 μg/ml for nalidixic acid, and 1 μg/ml for cefixime, higher sensitivity and specificity achieved. Compared to other tested antibiotics, a low rate of azithromycin resistance was observed. Nevertheless, higher resistance against fluoroquinolones was observed on NARS strain.ConclusionHigher susceptibility of Salmonella enterica to the conventional anti-typhoidal drugs (amoxicillin, chloramphenicol, cotrimoxazole, cephotaxime) advocates for its reconsideration. Although, the lower susceptibility against fluoroquinolones among nalidixic-acid-resistant Salmonella (NARS) strain negates its empirical use among the study age group.

Project description:BACKGROUND:The Chihuahua, the world's smallest dog breed, is a popular breed in the UK today. The VetCompass™ Programme collates de-identified clinical records from primary-care veterinary practices in the UK for epidemiological research. This study aimed to characterise the demography, age at death and common disorders of Chihuahuas under primary veterinary care during 2016 in the UK. RESULTS:Chihuahuas comprised 11,647/336,865 (3.46%) dogs under veterinary care during 2016. The annual proportional birth rate for Chihuahuas rose from 1.01% in 2005 to 5.35% in 2016. Median adult bodyweight was 3.4?kg (interquartile range [IQR]: 2.7-4.3, range 0.8-9.8).). Median age was 2.8?years (interquartile range [IQR] 1.6-4.9). Median age at death from this young expanding population was 8.2?years (IQR 3.5-12.1). Females (10.2?years) outlived males (6.9?years) (Mann-Whitney U test: P =?0.005). The most common grouped causes of death were heart disease (18.8%, 95% CI: 10.9-29.0), lower respiratory tract disorder (16.3%, 95% CI: 8.9-26.2) and traumatic injury (13.8%, 95% CI: 7.1-23.3). The most common specific disorders were periodontal disease (13.5%, 95% CI: 12.6-14.4), obesity (5.9%, 95% CI: 5.3-6.5), retained deciduous dentition (5.7%, 95% CI: 5.1-6.4), anal sac impaction (4.9%, 95% CI: 4.4-5.5) and aggression (4.2%, 95% CI: 3.7-4.8). Among the 28 most common fine-level disorders, males had statistically (P <? 0.005) higher probability than females for 5 disorders (aggression, heart murmur, otitis externa, conjunctivitis and upper respiratory tract infection). There were no disorders with statistically (P <? 0.005) higher prevalence in females. CONCLUSIONS:This study documented rising ownership and a currently youthful population of Chihuahuas in the UK. These results suggest that the Chihuahua is currently undergoing a popularity boom but veterinarians need to be watchful for welfare issues related to impulse purchase of Chihuahua puppies by owners with limited experience of dog care. Periodontal disease, obesity, retained deciduous dentition, anal sac impaction and aggression were identified as common health issues within the breed. The unique veterinary care needs of this popular miniature breed suggest that veterinarians should consider the value of advanced training in anesthesia and dentistry in small-sized dogs.

Project description:IntroductionPharmacotherapy for overactive bladder (OAB) is generally associated with low rates of persistence and adherence. This study was conducted to explore the patient journey in a UK primary care setting (experiences, perceptions, attitudes, and levels of engagement and expectations) and identify self-reported reasons for patient non-adherence and/or non-persistence to medications for OAB.MethodsThis was a qualitative, non-interventional study involving one-to-one semi-structured, face-to-face or phone interviews with individuals aged 40-80 years, diagnosed with OAB, and currently taking, or having taken, either antimuscarinic or β3-adrenoceptor agonist medications within the last 12 months. Thematic analyses of interview transcripts identified themes surrounding the participants' experiences with OAB.ResultsA total of 20 interviews were conducted (face-to-face, n = 13; telephone, n = 7). Interviews from five men and 13 women (mean age 70 years) were included in the final analysis. The most common OAB symptoms reported included urgency, frequency, incontinence and nocturia. Several key themes of factors influencing persistence and/or adherence to prescribed OAB medication were identified: patients' attitude and condition adaptation behaviour; support with treatment; unmet efficacy/tolerability expectations; drug/condition hierarchy. Non-adherence and/or non-persistence to OAB medication was largely intentional, with patients balancing side effects against perceived clinical benefits. Perceived lack of efficacy was the primary reason for discontinuing treatment. Other factors cited included side effects of medication (either experienced or a fear of future effects), a general aversion to long-term medication taking, drug/condition hierarchy relative to other comorbidities, and limited healthcare professional (HCP) support/engagement. Patients expressed condition adaptation behaviours to help self-manage their condition.ConclusionPersistence and adherence to OAB medication may be suboptimal. HCPs might be able to improve persistence and adherence by fostering realistic treatment expectations and scheduling regular medication reviews. These measures may help optimise patient care and support more adherent behaviours, thus minimising the impact of undertreated OAB on patient quality of life.FundingInnovate UK and Astellas Pharma Europe Ltd (APEL).

Dataset Information

Antibiotic-induced changes in the human gut microbiota for the most commonly prescribed antibiotics in primary care in the UK: a systematic review.

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Antibiotic-induced changes in the human gut microbiota for the most commonly prescribed antibiotics in primary care in the UK: a systematic review.

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