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Antibiotic use and risk of autism spectrum disorder and attention-deficit/hyperactivity disorder: a population-based

Kai-Lin Yang1, Ting-An Yen2, Fang-Ju Lin1,3,4

  • 1Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.

Child and Adolescent Psychiatry and Mental Health
|July 11, 2024
PubMed

Insights

Early childhood antibiotic exposure shows minimal impact on autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) risk. These findings suggest timely antibiotic use is appropriate, even with concerns about neurodevelopmental outcomes.

Area of Science:

  • Neuroscience
  • Pediatrics
  • Pharmacology

Background:

  • The gut-brain axis suggests a link between gut microbiota and neurodevelopment.
  • Previous studies on early antibiotic exposure and autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) risk have yielded inconsistent results.

Purpose of the Study:

  • To investigate the hypothesis that antibacterial agent exposure in the first two years of life increases the risk of ASD and/or ADHD.

Main Methods:

  • Retrospective cohort study utilizing Taiwan's National Health Insurance Research Database (2003-2019).
  • Included singleton, full sibling, and exposure-discordant sibling pair cohorts.
  • Analyzed children with at least one antibacterial prescription between 0-2 years and diagnosed with ASD/ADHD by age 15, adjusting for confounders using Cox proportional hazards models.

Main Results:

  • Antibiotic exposure showed a marginal increase in ASD/ADHD risk in singleton (aHR: 1.06) and full sibling (aHR: 1.03) cohorts.
  • A slight decrease in risk was observed in the exposure-discordant sibling pair cohort (aHR: 0.92).
  • The study analyzed over 946,000 children in the singleton cohort alone.

Conclusions:

  • Early life antibiotic exposure appears to have a minimal impact on the risk of ASD and/or ADHD.
  • Given the marginal and near-null estimated effects, concerns should not prevent timely and appropriate antibiotic use.
  • Further research may explore nuanced effects within specific antibiotic classes or exposure timings.
Abstract

Keywords:
Antibacterial agentsAttention-deficit/hyperactivity disorderAutism spectrum disorderGut microbiotaGut–brain axis

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