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Association between antibiotic exposure and childhood atopic dermatitis: a systematic review and meta-analysis
Huawei Zhao1,2, Yijun Luo3, Wenmi Li3
1Department of Pharmacy, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310052, China.
Insights
Antibiotic exposure in pregnancy and childhood increases the risk of childhood atopic dermatitis (AD). Childhood exposure poses a higher risk than prenatal exposure, highlighting the need for careful antibiotic use in children.
Area of Science:
- Pediatric Health
- Dermatology
- Epidemiology
Background:
- Antibiotics are frequently prescribed for children, raising concerns about long-term health effects.
- Childhood atopic dermatitis (AD) is a prevalent condition, with higher rates in children than adults.
- The potential link between early-life antibiotic exposure and AD risk is a significant public health concern.
Purpose of the Study:
- To conduct a meta-analysis assessing the association between antibiotic exposure and the risk of childhood atopic dermatitis (AD).
- To investigate the impact of exposure timing (prenatal vs. childhood) and other factors on AD risk.
Main Methods:
- Comprehensive literature search across major English and Chinese databases up to May 2025.
- Random-effects meta-analysis of 39 studies involving 7,487,925 children.
- Subgroup analyses to explore influencing factors like diagnostic criteria, race, and age.
Main Results:
- Antibiotic exposure during pregnancy and childhood is linked to an increased risk of childhood AD (OR = 1.22).
- Childhood antibiotic exposure showed a higher risk of AD compared to prenatal exposure.
- Risk was influenced by diagnostic criteria, race, antibiotic frequency, and type, but not living areas.
Conclusions:
- Early-life antibiotic exposure, particularly during childhood, elevates the risk of developing atopic dermatitis.
- Factors such as diagnostic criteria, race, and specific antibiotic characteristics modify this association.
- While statistically significant, findings require cautious interpretation and further high-quality research.
Background:
Antibiotics constitute a prevalent class of medications prescribed for pediatric patients. Concerns have arisen regarding the impact of early-life antibiotic use on the risk of atopic illnesses, including childhood atopic dermatitis (AD). AD affects approximately 2% of adults but is twice as prevalent in children, with rates ranging up to 4%. Therefore, the potential correlation between antibiotic exposure and childhood AD is of significant concern.
Methods:
Relevant literature was searched from English databases (PubMed, Web of science, Scopus, and The Cochrane Library) and Chinese databases (CNKI database, VIP Database, Wanfang Database) to May 1, 2025. Random-effects meta-analyses were conducted to assess the association between antibiotic exposure and the risk of childhood AD. This study is registered with PROSPERO (CRD42024535141).
Findings:
A total of 39 literature sources were included, encompassing 7,487,925 children. Meta-analysis showed that antibiotic exposure during pregnancy and childhood is associated with an increased risk of childhood AD (OR = 1.22, 95% CI: 1.17-1.28; heterogeneity: I2 = 98.06%). The subgroup analyses showed that: (1) Children exposed to antibiotics during childhood had a higher risk of developing AD compared to those exposed to antibiotics during pregnancy; (2) the increased risk of AD following antibiotic exposure was significantly affected by the diagnostic criteria and race, but not living areas; (3) antibiotic exposure frequency and type of antibiotics may contribute to the increased risk of AD following antibiotic exposure; (4) the increased risk of AD following antibiotic exposure seems to be positive related with age of outcome measure but not the age of exposure.
Interpretation:
Antibiotic exposure during pregnancy or early childhood enhances AD risk, with childhood exposure posing a higher risk than prenatal exposure. Exposure time (during pregnancy and childhood) and the age at outcome measurement are important influencing factors for this association. Diagnostic criteria, race, frequency of antibiotic exposure, and type of antibiotics may also affect this relationship. While the observed statistical significance may be associated with the increased statistical power afforded by the large sample size, the clinical implications of these findings warrant cautious interpretation. Further comprehensive and high-quality studies are warranted to clarify these findings.
Funding:
This work was supported by the Natural Science Foundation of Zhejiang (LYY22H310002), the Medical Science and Technology Project of Zhejiang Province (2024KY1170), Special Fund for the Incubation of Young Clinical Scientist, The Children's Hospital of Zhejiang University School of Medicine (CHZJU2023YS006).
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