University HealthCare Alliance

January 18, 2020

When Lab Tests are Misleading: A Mystery in Antibiotic Resistance

Most children with antibiotic-resistant urinary tract infections get better when taking less powerful antibiotics than lab tests say they need, a new Stanford study has shown. The findings, published in Pediatrics, may change how doctors treat this common type of childhood infection.

Antibiotic resistance is a growing concern for treatment of pediatric UTIs, said the study’s senior author, Stanford pediatrician Alan Schroeder, MD. Over the last two decades, doctors have had to switch from mild to medium-strength antibiotics to treat kids’ UTIs, and there is evidence that the E. coli bacteria that cause UTIs are developing resistance to these drugs, too.

Schroeder wants to slow the bugs-vs-drugs arms race. If doctors prescribe unnecessarily powerful antibiotics, he said, over time, people will have harder-to-treat infections and there won’t be any antibiotics to use for them.

The study looked at medical records from 316 generally healthy children who had come down with highly resistant UTIs and were treated at six large U.S. medical centers. When their UTIs were diagnosed, the children got started on standard treatment, usually cephalosporin antibiotics. A few days later, lab-test results came back that said these kids had cephalosporin-resistant infections. Typically, when this news arrives, patients are switched to an even more powerful drug, regardless of whether or not they are getting better.

But, intriguingly, the children in the study had done well on the “wrong” antibiotic. Only seven children of 316 needed escalation of care — meaning they returned to the emergency room or were admitted to the hospital. And among the 230 kids whose clinical response was recorded in their medical records, almost three-quarters had improved symptoms after a few days on the wrong antibiotic.

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