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Updated: Jan 7, 2026
Microbiota Analysis Using Two-step PCR and Next-generation 16S rRNA Gene Sequencing
Published on: October 15, 2019
The association between antimicrobial exposure and subsequent multiple sclerosis risk: A systematic review and
Hassan K Salamatullah1, Lamar AboAljadiel2, Mumen H Halabi2
1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; Department of Neurology, Ministry of the National Guard Health Affairs, Jeddah, Saudi Arabia.
Background:
Multiple Sclerosis (MS) is a complex autoimmune inflammatory disease of the central nervous system with an incompletely understood etiology. Emerging evidence suggests a critical link between gut microbiome disruption and MS pathogenesis, with antibiotics potentially playing a significant role in microbiome alterations. We conducted a systematic review and meta-analysis to explore the relationship between antimicrobial exposure and the risk of developing MS.
Methods:
A comprehensive systematic review was conducted across four electronic databases, searching for studies until March 29, 2025. The meta-analysis included comparative studies examining antibiotic usage frequency prior to MS onset/diagnosis in MS patients versus control group. Adjusted odds ratios (OR) were pooled using the generic inverse variance method with corresponding 95% confidence intervals (CIs).
Results:
The analysis encompassed nine reports involving 109,784 participants (23,960 MS patients and 85,824 controls). A statistically significant association was observed between antibiotic exposure and MS odds (OR=1.18; 95% CI [1.03-1.36]; p = 0.02). Data source-based analysis showed that studies with high-quality registry data maintained the association (OR=1.36; 95% CI [1.17-1.58]; p < 0.0001). Time-trend analysis showed significant association when the exposure occurred ≥4 years prior MS onset/diagnosis (OR=1.26; 95% CI [1.19-1.33]). Stratified analysis revealed significant associations for multiple antimicrobial classes, including tetracyclines, macrolides, quinolones, nitrofurantoin, aminoglycosides, metronidazole, sulfonamides, and antimycotics.
Conclusion:
This meta-analysis reveals a significant association between antimicrobial exposures, particularly those based on high-quality data and occurring at least four years prior to MS onset/diagnosis, and increased MS incidence. Longitudinal, prospective studies are required to conclusively determine whether antibiotic exposure is a true risk factor for MS.
Insights
Antibiotic exposure is linked to an increased risk of developing Multiple Sclerosis (MS). This association is stronger with high-quality data and exposure at least four years before MS onset, warranting further investigation.
Area of Science:
- Neuroimmunology
- Microbiome Research
- Epidemiology
Background:
- Multiple Sclerosis (MS) is an autoimmune CNS disease with unknown causes.
- Gut microbiome disruption is implicated in MS pathogenesis.
- Antibiotics may significantly alter the microbiome, influencing MS risk.
Purpose of the Study:
- To systematically review and meta-analyze the relationship between antimicrobial exposure and MS risk.
- To explore the impact of antibiotic usage on the likelihood of developing MS.
Main Methods:
- Systematic review of four databases up to March 29, 2025.
- Meta-analysis of comparative studies on antibiotic use before MS onset.
- Pooled adjusted odds ratios (OR) using the generic inverse variance method.
Main Results:
- Nine reports with 109,784 participants (23,960 MS patients) were analyzed.
- Antibiotic exposure showed a significant association with increased MS odds (OR=1.18).
- Association remained significant with high-quality registry data (OR=1.36) and exposure ≥4 years prior (OR=1.26).
- Multiple antimicrobial classes were associated with increased MS risk.
Conclusions:
- Antimicrobial exposure, especially from high-quality data and ≥4 years pre-MS, is significantly associated with higher MS incidence.
- Further longitudinal, prospective studies are needed to confirm antibiotics as a definitive MS risk factor.
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