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Updated: May 28, 2025
Quantitative Polymerase Chain Reaction-based Analyses of Murine Intestinal Microbiota After Oral Antibiotic Treatment
Published on: November 17, 2018
Antibiotic Use and Risk of Microscopic Colitis in Older Adults: A Nationwide Self-Controlled Case Series Study
Máté Szilcz1, Jonas W Wastesson1,2, David Bergman1
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Background:
Several drugs have been linked to the risk of microscopic colitis (MC), a condition characterised by watery, non-bloody diarrhoea. Antibiotics can induce similar symptoms, but their connection to MC remains unclear.
Aim:
To investigate the antibiotic-related risks of MC in adults aged 65 years and older.
Methods:
This was a nationwide, self-controlled case series study including adults aged ≥ 65 years with a new prescription for antibiotics and biopsy-confirmed, incident MC (Sweden, 2007-17). We identified cases from the nationwide histopathology cohort ESPRESSO individually linked to several registers. Using conditional Poisson regression, we estimated incidence rate ratios (IRR) for four risk periods: on treatment, and 1-14, 15-91, and 92-365 days post-treatment, compared with the non-treatment periods in the same individual. We also conducted a negative control outcome analysis to assess whether the association was specific to MC or due to diagnostic workup. E-values were used to assess robustness to unmeasured confounding.
Results:
We identified 2393 persons with incident biopsy-confirmed MC (median age at diagnosis 74; 67% women). Compared with the non-treatment periods, the risk of MC in the age-adjusted analysis increased with antibiotic treatment (IRR: 1.44 [95% CI: 1.13-1.84], E-value: 2.24), 1-14 days (IRR: 1.12 [0.83-1.49]), 15-91 days (1.12 [0.97-1.31]) and 92-365 days post-treatment (1.19 [1.07-1.32]). The negative control outcome analysis showed similar risks of biopsy-confirmed normal mucosa after antibiotic use.
Conclusion:
The observed association between antibiotic use and MC may result from detection bias rather than a causal relationship.
Insights
Antibiotic use may not cause microscopic colitis (MC) in older adults. The study suggests the observed link might be due to detection bias, not a direct causal relationship, warranting further investigation into MC risk factors.
Area of Science:
- Gastroenterology
- Pharmacology
- Epidemiology
Background:
- Microscopic colitis (MC) is characterized by watery diarrhea.
- Several drugs are linked to MC, but the antibiotic-MC association is unclear.
- Older adults (≥65 years) are a focus for MC risk assessment.
Purpose of the Study:
- To investigate the association between antibiotic use and microscopic colitis (MC) risk in adults aged 65 years and older.
- To differentiate between a causal link and detection bias in antibiotic-associated MC.
Main Methods:
- Nationwide, self-controlled case series study (Sweden, 2007-2017).
- Included adults aged ≥65 years with new antibiotic prescriptions and biopsy-confirmed MC.
- Used conditional Poisson regression and negative control outcome analysis to assess MC risk during and after antibiotic treatment.
Main Results:
- Identified 2393 incident MC cases (median age 74, 67% women).
- Increased MC risk observed during antibiotic treatment (IRR: 1.44) and up to 365 days post-treatment (IRR: 1.19).
- Negative control analysis revealed similar risks for normal mucosa post-antibiotics, suggesting detection bias.
Conclusions:
- The association between antibiotic use and microscopic colitis may stem from detection bias.
- A causal relationship between antibiotics and MC in older adults is not supported by this study's findings.
- Further research is needed to understand the etiology of MC and potential confounding factors.
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