Correlation Between Individual Child-Level Antibiotic Consumption and Antibiotic-Resistant Among Commensal Escherichia coli: Results from a Cohort of Children Aged 1–3 Years in Rural Ujjain India

Figures & data

Table 1 Antibiotics and Their Respective Class for Which the Antibiotic Susceptibility Test Was Applied

Name	Class
Ampicillin	Penicillins
Cefotaxime	3rd generation cephalosporin
Ceftazidime	3rd generation cephalosporin
Nalidixic acid	Other fluoroquinolone
Co-trimoxazole (Trimethoprim/sulfamethoxazole)	Folatepathway inhibitors

Figure 1 Flow chart describing the study cohort and number of E.coli strains isolated from sample and included in the analysis, under study in rural Ujjain, India.

Table 2 Distribution of Antibiotic Consumption (DDD/100 Patient-Days) for Each of Antibiotic Class at 7-Time Points in Selected Cohort of Children (1–3 Years) During the Study Period

ATC	Antibiotics	Antibiotic Use (DDD/100 Patient-Days) by Time Points							p value
		1 Monsoon 2014	2 Winter 2015	3 Summer 2015	4 Monsoon 2015	5 Winter 2016	6 Summer 2016	7 Monsoon 2016
Total antibiotic consumption		51	60	54	66	51	46	57	0.46
J01C	Penicillins	38	43	41	80	32	27	42	0.78
J01CA04	Amoxicillin	28	29	28	50	28	15	29	0.69
J01DD	Cephalosporins	62	72	59	64	62	49	53	0.023*
J01DD08	Cefixime	75	100	81	78	68	46	67	0.034*
J01DD13	Cefpodoxime	35	38	34	44	39	100	27	0.53
J01MA	Fluoroquinolones	50	43	44	50	55	38	49	0.71
J01MA02	Ciprofloxacin	50	30	25	50	26	25	25	0.2
J01MA01	Ofloxacin	50	50	46	50	60	0	55	0.5
J01EE01	Co-trimoxazole	0	113	83	125	125	100	100	0.2

Notes: Cephalosporins includes cefixime, cefpodoxime and cefotaxime; penicillinsincludes ampicillin, amoxicillin, amoxicillin/clavulanate and ampicillin/cloxacillin; fluoroquinolones includes ofloxacin, ciprofloxacin, norfloxacin and levofloxacin; *Significant p value <0.05.

Figure 2 Overall cephalosporin consumption in the study cohort of children of 1–3 years of age at 7-time points, in defined daily doses (DDD) per 100 patient-days, in rural Ujjain, India.

Table 3 Percentage Distribution of E.coli Isolates Resistant to the Selected Antibiotic Class at 7-Time Points

Antibiotics	Resistant Isolates (R+I)*n (%)	Resistant Isolates by Time Points							p value
		1 N=632 n (%)	2 N=655 n (%)	3 N=675 n (%)	4 N=704 n (%)	5 N=676 n (%)	6 N=699 n (%)	7 N=693 n (%)
Ampicillin Resistant	3190 (67)	379 (60)	365 (56)	448 (66)	377 (54)	339 (50)	671 (96)	611 (88)	0.12
Cefotaxime Resistant	2062 (44)	313 (50)	253 (39)	322 (48)	318 (45)	263 (39)	260 (37)	333 (48)	0.55
Ceftazidime Resistant	1834 (39)	277 (44)	219 (33)	280 (41)	217 (31)	259 (38)	256 (37)	326 (47)	0.69
Nalidixic acid Resistant	2459 (52)	357 (56)	352 (54)	327 (48)	366 (52)	342 (51)	324 (46)	391 (56)	0.57
Co-trimoxazole Resistant	1292 (27)	163 (26)	134 (20)	205 (30)	205 (29)	176 (26)	169 (24)	240 (35)	0.25

Notes: N-total number of E.coli isolates tested for resistance.

Abbreviations: n, number of resistant isolates; *R+I, Resistant plus intermediate isolates.

Table 4 Mixed-Effects Logistic Regression Analyses of the Relationship Between the Antibiotic Consumption and Resistance Among Selected Antibiotics in the E.coli isolates from 125 Children at 7-Time Points Over the Period of 2 Years

Antibiotic Class Consumption	Antibiotic Tested for Resistance	Mixed-Effects Logistic Regression
		Coefficient ± SE^#	p value
Penicillins	Ampicillin	−0.75 (± 0.12)	0.16
Cephalosporins	Cefotaxime	0.13 (± 0.09)	<0.001*
Cephalosporins	Ceftazidime	−0.006 (± 0.09)	0.99
Fluoroquinolones	Nalidixic acid	−0.22 (± 0.14)	0.13
Folatepathway inhibitors	Co-trimoxazole	−0.38 (± 0.30)	0.21

Notes: *Significant p value <0.05.

Abbreviation: ^#SE, Standard error.