doi.org
Modelling impacts of paediatric amoxicillin shortage management on pneumococcal resistance and invasive disease in Europe | Nature Communications
Antibiotic shortages are increasing worldwide. Their impact on individual health and bacterial ecology is unknown, but it could be significant, and there is a lack of epidemiological evidence. Here, we assess the impact of beta-lactam shortage management on pneumococcal resistance and the incidence of invasive pneumococcal disease (IPD). We developed a mechanistic model of S. pneumoniae paediatric colonization and transmission, accounting for beta-lactam and macrolide exposure. We explored the effects of four antibiotic allocation strategies following a one-year beta-lactam shortage: lowering consumption frequency, shortening treatment duration, reducing the daily dose, or substituting beta-lactams with macrolides. These strategies were analyzed in different European pharmaco-epidemiological settings. We found heterogeneous impacts of allocation strategies, amplified at high shortage intensity. The adverse outcomes of shortages increased with baseline antibiotic consumption and the mai