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Antibiotics and asthma medication in a large register-based cohort study - confounding, cause and effect

C Almqvist1, B Wettermark, G Hedlin

  • 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. catarina.almqvist@ki.se

Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology
|November 19, 2011
PubMed

Insights

Antibiotic use in children is linked to asthma medication prescriptions, suggesting reverse causation or confounding by respiratory infections. Careful consideration is needed when prescribing antibiotics for early childhood respiratory symptoms.

Area of Science:

  • Pediatric pharmacology
  • Respiratory medicine
  • Infectious diseases

Background:

  • Established association between antibiotic use and asthma.
  • Debate exists regarding reverse causation and confounding by indication.

Purpose of the Study:

  • Investigate the association between different antibiotic classes and asthma medication prescriptions.
  • Utilize a Swedish national register-based cohort of children.

Main Methods:

  • Analysis of dispensed antibiotic (J01) and asthma medication (R03A-D) prescriptions.
  • Employed Cox regression and sequence symmetry analysis.

Main Results:

  • Strong association observed between antibiotic and asthma medication prescriptions in 211,192 children.
  • Higher hazard ratios for asthma medication linked to amoxicillin, penicillin, cephalosporins, and macrolides compared to other antibiotic classes.
  • Broad-spectrum antibiotics showed significantly higher hazard ratios than narrow-spectrum ones.

Conclusions:

  • Findings suggest reverse causation or confounding by respiratory tract infections explains the antibiotic-asthma association.
  • Highlights the need for careful clinical judgment when prescribing antibiotics versus asthma medication for early childhood respiratory symptoms.
Abstract

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