One thing no one should be nostalgic for is untreatable bacterial infections. Sadly, if a rerun has not yet arrived, we're certainly seeing the trailers. Well over half the children with urinary tract infections (UTIs) worldwide carry forms of bacteria resistant to a common antibiotic, a review of 58 studies has found. Resistance is rarer, but still frighteningly common, against a variety of alternative antibiotics.

Reports of growing antibiotic resistance have been appearing for decades, but a review in the British Journal of Medicine has brought the evidence together, combining 58 published studies from 26 countries on E. coli UTIs. E. coli accounts for more than 80 percent of UTIs worldwide. Among the 77,783 children in this research, resistance to ampicillin was the norm, not the exception.

The authors divided these studies into those conducted in Organization for Economic Co-operation and Development (OECD) countries, and those in the rest of the world. Within the OECD, ampicillin resistance was 53.4 percent; outside it was 79.8 percent.

The wealth-induced gap was even higher for other treatments. Only 2.1 percent of infected children in the OECD carried bacteria resistant to ciproflaxcin, but the figure was more than 12 times higher – 26.8 percent – elsewhere.

^{E. coli, an enemy once thought defeated, is well on the way back. Everett Historical/Janice Haney Carr/Shutterstock}

The authors speculate that the difference may be because antibiotics are often available without a prescription in non-OECD countries. Dr. Céire Costelloe of Imperial College London said in a statement, "The results also suggest previous antibiotic use increased the subsequent risk of E. coli resistance to that particular antibiotic – for up to six months after treatment."

When bacteria develop resistance to just one antibiotic we can switch to others, but multiple resistance is deeply worrying.“Antibiotic-resistant infections are also twice as likely to be associated with greater morbidity and mortality and are associated with increased healthcare costs,” the authors noted. The second-line drugs, used to treat infections resistant to common antibiotics, are too expensive for many of the non-OECD countries where some of these studies were done to afford easily.

UTIs are not only painful, but in children can easily lead to kidney damage and even complete renal failure.

In an accompanying editorial, Professor Grant Russell of Monash University, Australia, argues the findings should be a wake-up call to doctors and public health workers worldwide. “The findings confront long established patterns of practice,” he wrote.

Russell pointed out that drugs should not be used as first-line treatments where resistance exists in more than 20 percent of cases of the likely infected strain. This is already the case, on average, for two of the four drugs studied in OECD countries, and three in the rest of the world. In many individual countries, resistance would exceed this mark against all four antibiotics. Russell argued doctors need to use “antibiotic histories” and rotate the drugs children are given. He advocated a “whole of society” approach to the fight against antibiotic resistance.