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Antibiotic use and inflammatory bowel diseases in childhood
Anders Hviid1, Henrik Svanström, Morten Frisch
1Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark. aii@ssi.dk
Insights
Childhood antibiotic use is linked to a higher risk of inflammatory bowel diseases (IBD), particularly Crohn's disease (CD). This association was strongest with frequent antibiotic courses and shortly after use.
Area of Science:
- Pediatric Gastroenterology
- Microbiome Research
- Environmental Epidemiology
Background:
- Intestinal microflora composition is implicated in inflammatory bowel diseases (IBD) development.
- Antibiotics can significantly alter gut microbiota.
- Childhood antibiotic exposure is a potential environmental factor for IBD.
Purpose of the Study:
- To investigate the association between antibiotic use and IBD in children.
- To quantify the risk of IBD following antibiotic exposure in early life.
Main Methods:
- Nationwide cohort study of Danish children (N=577,627) born 1995-2003.
- Analysis of antibiotic prescriptions, IBD diagnoses, and confounding variables.
- Poisson regression used to calculate rate ratios (RRs) for IBD based on antibiotic use patterns.
Main Results:
- 117 IBD cases diagnosed over 3,173,117 person-years.
- Antibiotic users had a 1.84 times higher RR of IBD compared to non-users.
- The association was specific to Crohn's disease (RR 3.41), strongest within 3 months post-use (RR 4.43), and with ≥7 courses (RR 7.32).
Conclusions:
- Childhood antibiotic use shows a strong association with pediatric Crohn's disease.
- This prospective study highlights antibiotics as a potential environmental risk factor for CD.
- Causality is not proven; confounding by indication (undiagnosed CD symptoms leading to antibiotic prescription) is a consideration.
Background:
The composition of the intestinal microflora has been proposed as an important factor in the development of inflammatory bowel diseases (IBD). Antibiotics have the potential to alter the composition of the intestinal microflora. A study was undertaken to evaluate the potential association between use of antibiotics and IBD in childhood.
Methods:
A nationwide cohort study was conducted of all Danish singleton children born from 1995 to 2003 (N=577,627) with individual-level information on filled antibiotic prescriptions, IBD and potential confounding variables. Using Poisson regression, rate ratios (RRs) of IBD were calculated according to antibiotic use. Antibiotic use was classified according to time since use, type, number of courses used and age at use.
Results:
IBD was diagnosed in 117 children during 3,173,117 person-years of follow-up. The RR of IBD was 1.84 (95% CI 1.08 to 3.15) for antibiotic users compared with non-users. This association appeared to be an effect on Crohn's disease (CD) alone (RR 3.41) and was strongest in the first 3 months following use (RR 4.43) and among children with ≥7 courses of antibiotics (RR 7.32).
Conclusions:
Antibiotic use is common in childhood and its potential as an environmental risk factor for IBD warrants scrutiny. This is the first prospective study to show a strong association between antibiotic use and CD in childhood. However, as with any observational study, causality cannot be inferred from our results and confounding by indication--in particular, prescribing of antibiotics to children with intestinal symptoms of as yet undiagnosed CD--should also be considered as a possible explanation.
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