Effects of penicillin V on the faecal microbiota in patients with pharyngotonsillitis - an observational study
(2023) In JAC-Antimicrobial Resistance 5(1).- Abstract
Background: The intestinal microbiota functions as a reservoir of antibiotic resistance. Objectives: To evaluate penicillin V (phenoxymethylpenicillin) effects on the faecal microbiota with focus on beta-lactam resistance. Methods: We included 31 primary care patients with group A streptococcal pharyngotonsillitis treated with penicillin V for 5 (800mg×4) or 10days (1000mg×3). Twenty-nine patients contributed with three faecal swab samples each. The faecal specimens were collected at the start of penicillin V treatment, after the last dose and at follow-up 7-9days after completed treatment. Samples were inoculated semiquantitatively on selective screening agar plates to study beta-lactam resistance, species shifts among Enterobacterales... (More)
Background: The intestinal microbiota functions as a reservoir of antibiotic resistance. Objectives: To evaluate penicillin V (phenoxymethylpenicillin) effects on the faecal microbiota with focus on beta-lactam resistance. Methods: We included 31 primary care patients with group A streptococcal pharyngotonsillitis treated with penicillin V for 5 (800mg×4) or 10days (1000mg×3). Twenty-nine patients contributed with three faecal swab samples each. The faecal specimens were collected at the start of penicillin V treatment, after the last dose and at follow-up 7-9days after completed treatment. Samples were inoculated semiquantitatively on selective screening agar plates to study beta-lactam resistance, species shifts among Enterobacterales and enterococci, and colonization with Candida spp. and Clostridioides difficile. Representative colonies were identified using MALDI-TOF. Results were analysed by non-parametric statistical methods. Results: An increase in the proportion of patients colonized with ampicillin-resistant Enterobacterales, from 52% to 86% (P=0.007), and Enterobacterales with decreased susceptibility to third-generation cephalosporins, from 32% to 52% (P=0.034), was observed between the first and second samples. This increase was no longer significant at follow-up. New colonization with ampicillin-resistant Enterobacterales species and non-Enterobacterales Gram-negative species was observed, and persisted at follow-up. Conclusions: Following treatment with penicillin V, we observed decreased susceptibility to ampicillin and third-generation cephalosporins, and prolonged colonization with non-Escherichia coli Gram-negative species. These findings challenge the perception that penicillin V has limited ecological effect on the intestinal microbiota, and emphasizes the importance of avoiding even narrow-spectrum antimicrobials when possible.
(Less)
- author
- Rystedt, Karin ; Edquist, Petra ; Giske, Christian G. ; Hedin, Katarina LU ; Tyrstrup, Mia LU ; Ståhlgren, Gunilla Skoog ; Sundvall, Pär Daniel and Edlund, Charlotta
- organization
- publishing date
- 2023-02-01
- type
- Contribution to journal
- publication status
- published
- subject
- in
- JAC-Antimicrobial Resistance
- volume
- 5
- issue
- 1
- article number
- dlad006
- publisher
- Oxford University Press
- external identifiers
-
- pmid:36816747
- scopus:85156262621
- ISSN
- 2632-1823
- DOI
- 10.1093/jacamr/dlad006
- language
- English
- LU publication?
- yes
- id
- 62cadd1b-94b2-4609-bce2-2ad2259856bd
- date added to LUP
- 2023-08-14 08:51:36
- date last changed
- 2024-04-20 00:29:26
@article{62cadd1b-94b2-4609-bce2-2ad2259856bd,
abstract = {{<p>Background: The intestinal microbiota functions as a reservoir of antibiotic resistance. Objectives: To evaluate penicillin V (phenoxymethylpenicillin) effects on the faecal microbiota with focus on beta-lactam resistance. Methods: We included 31 primary care patients with group A streptococcal pharyngotonsillitis treated with penicillin V for 5 (800mg×4) or 10days (1000mg×3). Twenty-nine patients contributed with three faecal swab samples each. The faecal specimens were collected at the start of penicillin V treatment, after the last dose and at follow-up 7-9days after completed treatment. Samples were inoculated semiquantitatively on selective screening agar plates to study beta-lactam resistance, species shifts among Enterobacterales and enterococci, and colonization with Candida spp. and Clostridioides difficile. Representative colonies were identified using MALDI-TOF. Results were analysed by non-parametric statistical methods. Results: An increase in the proportion of patients colonized with ampicillin-resistant Enterobacterales, from 52% to 86% (P=0.007), and Enterobacterales with decreased susceptibility to third-generation cephalosporins, from 32% to 52% (P=0.034), was observed between the first and second samples. This increase was no longer significant at follow-up. New colonization with ampicillin-resistant Enterobacterales species and non-Enterobacterales Gram-negative species was observed, and persisted at follow-up. Conclusions: Following treatment with penicillin V, we observed decreased susceptibility to ampicillin and third-generation cephalosporins, and prolonged colonization with non-Escherichia coli Gram-negative species. These findings challenge the perception that penicillin V has limited ecological effect on the intestinal microbiota, and emphasizes the importance of avoiding even narrow-spectrum antimicrobials when possible.</p>}},
author = {{Rystedt, Karin and Edquist, Petra and Giske, Christian G. and Hedin, Katarina and Tyrstrup, Mia and Ståhlgren, Gunilla Skoog and Sundvall, Pär Daniel and Edlund, Charlotta}},
issn = {{2632-1823}},
language = {{eng}},
month = {{02}},
number = {{1}},
publisher = {{Oxford University Press}},
series = {{JAC-Antimicrobial Resistance}},
title = {{Effects of penicillin V on the faecal microbiota in patients with pharyngotonsillitis - an observational study}},
url = {{http://dx.doi.org/10.1093/jacamr/dlad006}},
doi = {{10.1093/jacamr/dlad006}},
volume = {{5}},
year = {{2023}},
}