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Published on: November 17, 2018
Early Childhood Antibiotics and Chronic Pediatric Conditions: A Retrospective Cohort Study
Matthew A Beier1,2, Soko Setoguchi3,4,5, Tobias Gerhard4,5,6
1Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA.
Insights
Early antibiotic use in children is linked to increased risks of asthma, food allergies, allergic rhinitis, and intellectual disability, especially with multiple prescriptions. Most other chronic conditions showed minimal associations.
Area of Science:
- Pediatric Health
- Pharmacology
- Epidemiology
Background:
- Early-childhood antibiotic exposure is a potential risk factor for chronic pediatric conditions.
- Previous studies faced challenges with unmeasured confounding factors.
- This study investigates the link between early antibiotic use and allergic, autoimmune, and neurodevelopmental/psychiatric conditions.
Purpose of the Study:
- To evaluate the association between antibiotic prescriptions in the first two years of life and the development of chronic pediatric conditions.
- To assess the impact of antibiotic exposure on allergic, autoimmune, and neurodevelopmental/psychiatric outcomes.
- To minimize confounding bias through robust statistical methods.
Main Methods:
- Retrospective cohort study utilizing UK electronic health records (1987-2020).
- Primary exposure: antibiotic prescriptions between birth and age 2.
- Outcomes: diagnoses of asthma, food allergy, allergic rhinitis, autoimmune diseases, neurodevelopmental/psychiatric disorders, and forearm fracture (negative control).
- Statistical analysis: multivariable Cox regression and sibling-matched conditional Cox regression.
Main Results:
- Antibiotic exposure before age 2 was associated with increased risk of asthma (HR 1.24), food allergy (HR 1.33), and allergic rhinitis (HR 1.06).
- A dose-dependent association was found with intellectual disability (5+ vs. 1-2 courses: HR 1.73; sibling-matched HR 2.79).
- No significant associations were observed for most autoimmune, neurodevelopmental, and psychiatric conditions. Sibling-matched analyses indicated minimal confounding.
Conclusions:
- Multiple courses of antibiotics in early childhood are associated with higher likelihoods of developing asthma, food allergies, allergic rhinitis, and intellectual disability.
- The study suggests minimal risks for most autoimmune, neurodevelopmental, and psychiatric conditions following early antibiotic exposure.
- Findings highlight the importance of judicious antibiotic use in young children.
Background:
Early childhood antibiotics have been implicated in chronic pediatric conditions, but many studies leave concerns about unmeasured confounding. We evaluated associations between early childhood antibiotics and multiple pediatric conditions.
Methods:
We performed a retrospective cohort study using electronic health records data (United Kingdom, 1987-2020). The primary exposure was antibiotic prescriptions between birth and age 2 years. Outcomes were newly diagnosed chronic pediatric conditions (asthma/allergic, autoimmune, neurodevelopmental/psychiatric) or forearm fracture (negative control). Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using multivariable Cox regression models adjusted for maternal, child, and area-based socioeconomic covariates. Sibling-matched analyses were conducted using conditional Cox regression.
Results:
Among 1 091 449 children, antibiotic exposure before age 2 was positively associated with asthma (HR, 1.24 [95% CI, 1.22-1.26]), food allergy (HR, 1.33 [95% CI, 1.26-1.40]), and allergic rhinitis (HR, 1.06 [95% CI, 1.03-1.10]), with stronger associations with multiple antibiotic courses. Sibling-matched analyses yielded similar findings. Early childhood antibiotic exposure was also dose-dependently associated with intellectual disability (≥5 vs 1-2 courses: HR, 1.73 [95% CI, 1.49-2.01]; sibling-matched: HR, 2.79 [95% CI, 1.87-4.18]). Consistent associations were not observed for celiac disease, inflammatory bowel disease, juvenile idiopathic arthritis, psoriasis, type 1 diabetes, attention-deficit/hyperactivity disorder, autism spectrum disorders, or anxiety. Sibling-matched results and a negative control outcome suggested minimal confounding.
Conclusions:
Children receiving multiple antibiotic courses before age 2 were more likely to develop asthma, food allergies, allergic rhinitis, and intellectual disability. However, antibiotic-associated risks of most autoimmune, neurodevelopmental, and psychiatric conditions studied were minimal.
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