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Published on: August 7, 2017

Relation of early antibiotic use to childhood asthma: confounding by indication?

Y Su1, J Rothers, D A Stern

  • 1Arizona Respiratory Center, College of Public Health, Department of Pharmacology, University of Arizona, Tucson, AZ 85724, USA.

Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology
|June 16, 2010
PubMed

Insights

Early antibiotic use did not cause childhood asthma. The apparent link was due to more doctor visits for illness, which led to both antibiotic prescriptions and increased asthma risk.

Area of Science:

  • Pediatric Allergy and Immunology
  • Epidemiology
  • Microbiome Research

Background:

  • Inconsistent findings exist regarding early antibiotic exposure and childhood asthma development.
  • Methodological limitations may explain discrepancies in previous studies.
  • Confounding by indication is a potential bias in observational research.

Purpose of the Study:

  • To evaluate the influence of confounding by indication on the association between early antibiotic use and asthma up to age 5.
  • To investigate this relationship in a non-selected birth cohort of 424 children.

Main Methods:

  • Assessed oral antibiotic use through nurse interviews in the first 9 months of life.
  • Diagnosed asthma and eczema via questionnaires at ages 1, 2, 3, and 5 years.
  • Controlled for physician visits for illness to address confounding by indication.

Main Results:

  • No significant association found between early antibiotic use and eczema or allergen-specific IgE.
  • A dose-response relationship was observed between antibiotic use and ever asthma (OR=1.5, P=0.047).
  • Asthma risk increased significantly with the number of physician visits for illness (P<0.001); this association disappeared after adjustment.

Conclusions:

  • The observed link between early antibiotic use and childhood asthma in this cohort is likely an artifact.
  • The number of physician visits for illness strongly influences both antibiotic prescription and asthma risk.
  • Confounding by indication is a critical factor to consider in antibiotic-asthma research.
Abstract

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