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Risk of fibromyalgia following antibiotic prescriptions: A population-based case-control study
David Armstrong1, Alex Dregan2, Mark Ashworth1
1Department of Population Health Sciences, King's College London, London, UK.
Background:
The health of the gut microbiome is now recognized to be an important component of the gut-brain axis which itself appears to be implicated in pain perception. Antibiotics are known to create dysbiosis in the microbiome, so whether fibromyalgia is more commonly diagnosed after antibiotic prescriptions provides a means of exploring the role of the microbiome in the experience of chronic pain.
Methods:
A case-control study was carried out using electronic health records collected in the UK's Clinical Practice Research Datalink (CPRD), a comprehensive database of primary care consultations. For each case of diagnosed fibromyalgia, three controls were identified and matched by age, gender and GP practice. The exposure variable was the number and timing of antibiotic prescriptions over previous years. The analysis involved adjusting for a wide range of co-variates that might be possible confounders.
Results:
A total of 44,674 cases of fibromyalgia were identified together with 133,513 controls. After adjusting for co-variates, it was found that both the total number of prescriptions and their timing was associated with an FM diagnosis. For example, the quartile with the highest number of prescriptions and that with the longest exposure had a greater than three-fold increase in FM diagnoses (number of prescriptions: odds ratio 3.92; 95% CIs: 3.71-4.13; exposure odds ratio 3.28; CIs: 3.13-3.43). Some antibiotics (such as tetracyclines and metronidazole) seemed to confer greater risk than others.
Conclusions:
The results lend support for prior antibiotics being an important risk factor for a diagnosis of FM.
Significance:
This study shows an association between the volume as well as timing of prior antibiotic prescriptions and of a subsequent diagnosis of fibromyalgia in primary care.
Insights
Prior antibiotic use, particularly high volume and long exposure, significantly increases the risk of fibromyalgia diagnosis. This highlights the gut microbiome's role in chronic pain conditions.
Area of Science:
- Gut microbiome research
- Neuroscience
- Pain perception
Background:
- Gut microbiome health is crucial for the gut-brain axis, influencing pain perception.
- Antibiotics can disrupt the gut microbiome, potentially impacting chronic pain conditions like fibromyalgia.
Purpose of the Study:
- To investigate if fibromyalgia diagnoses are more common following antibiotic prescriptions.
- To explore the role of the gut microbiome in fibromyalgia through antibiotic use patterns.
Main Methods:
- A UK case-control study utilized electronic health records from the Clinical Practice Research Datalink (CPRD).
- 44,674 fibromyalgia cases were matched with 133,513 controls based on age, gender, and GP practice.
- Antibiotic prescription history (number and timing) was analyzed as the exposure variable, adjusting for confounders.
Main Results:
- A significant association was found between prior antibiotic prescriptions and fibromyalgia diagnosis.
- Higher numbers of prescriptions and longer exposure times correlated with increased fibromyalgia risk (OR 3.92 and 3.28, respectively).
- Certain antibiotics, like tetracyclines and metronidazole, appeared to confer a greater risk.
Conclusions:
- Prior antibiotic use is an important risk factor for fibromyalgia diagnosis.
- The volume and timing of antibiotic prescriptions are associated with subsequent fibromyalgia diagnoses in primary care.
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