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Exposure to systemic antibiotics in outpatient care and the risk of multiple sclerosis
Jussi Ot Sipilä1, Matias Viitala2, Arno Hänninen3
1Department of Neurology, Siun Sote, North Karelia Central Hospital, Joensuu, Finland and Clinical Neurosciences, University of Turku, Turku, Finland.
Background:
Infections, early life exposures and the microbiome have been associated with the aetiology of multiple sclerosis (MS). Data on any possible roles of antibiotics is scarce and conflicting.
Objective:
The objective of this study was to investigate associations between outpatient systemic antibiotic exposure and the risk of MS in a nationwide case-control setting.
Methods:
Patients with MS were identified from the nation MS registry and their exposure to antibiotics was compared with that of persons without MS, provided by the national census authority. Antibiotic exposure was investigated using the national prescription database and analyzed by Anatomical Therapeutic Chemical (ATC) category.
Results:
Among the 1830 patients with MS and 12765 control persons, there were no associations between exposure to antibiotics in childhood (5-9 years) or adolescence (10-19 years) and the subsequent risk of MS. There was also no association between antibiotic exposure 1-6 years before disease onset and the risk of MS, save for exposure to fluoroquinolones in women (odds ratio: 1.28; 95% confidence interval: 1.03, 1.60; p = 0.028) which is probably associated with the increased infection burden in the MS prodrome.
Conclusion:
Use of systemic prescription antibiotics was not associated with subsequent MS risk.
Insights
Systemic antibiotic use in children and adolescents was not linked to multiple sclerosis (MS) risk. A small association with fluoroquinolones in women was likely due to increased infection during MS prodrome.
Area of Science:
- Neurology
- Epidemiology
- Microbiology
Background:
- Multiple sclerosis (MS) etiology is linked to infections, early life exposures, and the microbiome.
- Existing data on antibiotic roles in MS is limited and contradictory.
Purpose of the Study:
- To examine the association between outpatient systemic antibiotic exposure and the risk of developing MS.
- Utilizing a nationwide case-control design to assess antibiotic use and MS incidence.
Main Methods:
- A nationwide case-control study comparing MS patients from the national registry with controls from the national census.
- Antibiotic exposure was analyzed using the national prescription database, categorized by Anatomical Therapeutic Chemical (ATC) codes.
Main Results:
- No association was found between antibiotic exposure in childhood or adolescence and subsequent MS risk.
- Antibiotic exposure 1-6 years prior to disease onset showed no link to MS risk, except for fluoroquinolones in women, potentially linked to the MS prodrome infection burden.
Conclusions:
- Systemic prescription antibiotic use does not appear to be associated with an increased subsequent risk of MS.
- The findings suggest that common antibiotic use is unlikely a primary driver for MS development.
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