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Journal of Antimicrobial Chemotherapy (2002) 50, 241-247
© 2002 The British Society for Antimicrobial Chemotherapy

How strong is the evidence that antibiotic use is a risk factor for antibiotic-resistant, community-acquired urinary tract infection?

Sharon L. Hillier1, John T. Magee2, Anthony J. Howard2 and Stephen R. Palmer1,*

1 Department of Epidemiology, Statistics and Public Health, University of Wales College of Medicine, Heath Park, Cardiff CF4 4XW; 2 PHLS in Wales, University of Wales Hospital, Cardiff, UK

Received 23 November 2001; returned 15 March 2002; revised 10 April 2002; accepted 16 May 2002

The prevalence of antibiotic resistance in community-acquired infections is rising but in contrast to popular perception there has been little published work on its epidemiology. This systematic review evaluates the published evidence on the relationship between antibiotic prescribing and antibiotic resistance of organisms causing community-acquired urinary tract infection. Fourteen papers met the inclusion criteria and these reported on five ecological studies and ten studies of individuals. Only one ecological study provided good evidence of a link with prescribing rates. The remaining studies had no control for population differences in demographics and/or no comparison population. Studies at the individual level lacked clear case definitions and statistical power. Until the epidemiology of antibiotic resistance is better defined the design of effective interventions will not be possible.

* Corresponding author. Tel: +44-2920-742321; Fax: +44-2920-742898; E-mail: palmersr{at}cardiff.ac.uk


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