Issue 06

Clinical Question

Does early childhood exposure to antibiotics increase the risk of IBD?

Editor’s Bottom Line

This analysis provides more evidence that early life exposure to antibiotics is associated with an increased subsequent risk of IBD. Ongoing large cohort studies may provide further insight into the microbial pathogenesis of Crohn’s disease (CD) and ulcerative colitis (UC).

Reference

Troelsen FS, Jick S. Antibiotic Use in Childhood and Adolescence and Risk of Inflammatory Bowel Disease: A Case–Control Study in the UK Clinical Practice Research Datalink. Inflamm Bowel Dis. 2020;26(3):440–47; https://doi.org/10.1093/ibd/izz137

Synopsis

To determine whether antibiotic use increases the risk of IBD, researchers in the United Kingdom conducted a case-control analysis of data from the United Kingdom Clinical Practice Research Datalink GOLD (CPRD GOLD), which includes information from over 35 million patient lives treated at 1,200 primary care practices. They identified 461 patients with UC and 683 with CD, who were diagnosed between 1998 and 2017. Each patient had at least 10 years of data available prior to diagnosis. IBD cases were matched to four controls without IBD based on several variables, such as age and sex. Analyses examined possible links between IBD risk and antibiotic use according to the number of prescriptions prior to IBD diagnosis, the class and type of antibiotics prescribed, and timing of exposure to antibiotics relative to the index date.

Results revealed that the risks of UC and CD were not increased by receiving at least one prescription for any antibiotic (Odds Ratio [OR] for UC: 1.02; 95% Confidence Interval [CI], 0.72–1.44 and OR for CD: 1.01; 95% CI, 0.73–1.39). However, there was a higher risk of CD among those who received at least one prescription for quinolones (OR: 1.76; 95% CI, 1.00–3.11) or metronidazole specifically (OR: 1.43; 95% CI, 0.87–2.34). When analyses were limited to patients registered in the database before three months of age, those who had received an antibiotic prior to five years of age were more than twice as likely as those who had not received an antibiotic during this period to develop CD (OR, 2.20; 95% CI, 0.75–6.43).

The authors write, “These findings are consistent with previous literature and suggest that early childhood exposure to antibiotics may play a role in destabilizing commensal gut flora and thereby the risk of developing CD later in life.”

Details

Study Design: Retrospective case-control
Funding: None
Allocation: Not applicable
Setting: National database
Level of Evidence: 4 (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.