Inflammatory bowel disease is associated with childhood antibiotic exposure
Inflammatory bowel disease includes ulcerative colitis and Crohn's disease where the immune system attacks the large intestine and small intestine respectively. Considering the emerging science on the profound importance of the human micro biome for immune system maturation, regulation and tolerance, a study just published in the journal Pediatrics offering evidence that antibiotic exposure in childhood is associated with inflammatory bowel disease comes as no surprise. The authors' intent was...
"To determine whether childhood antianaerobic antibiotic exposure is associated with the development of inflammatory bowel disease (IBD)."
To that end they examined data on 1,072,426 children from 464 ambulatory medical practices in the UK. None had a previous diagnosis of inflammatory bowel disease. They were followed for five years or until they were 19 years of age, during which time all antibiotic prescriptions were recorded. The antibiotics were penicillin, amoxicillin, ampicillin, penicillin/β-lactamase inhibitor combinations, tetracyclines, clindamycin, metronidazole, cefoxitin, carbapenems, and oral vancomycin. The data showed a striking association between antibiotic use and the subsequent development of inflammatory bowel disease:
"A total of 1 072 426 subjects contributed 6.6 million person-years of follow-up; 748 developed IBD. IBD incidence rates among antianaerobic antibiotic unexposed and exposed subjects were 0.83 and 1.52/10 000 person-years, respectively, for an 84% relative risk increase. Exposure throughout childhood was associated with developing IBD, but this relationship decreased with increasing age at exposure. Exposure before 1 year of age had an adjusted hazard ratio of 5.51 but decreased to 2.62 and 1.57 by 5 and 15 years, respectively. Each antibiotic course increased the IBD hazard by 6%. A dose-response effect existed, with receipt of >2 antibiotic courses more highly associated with IBD development than receipt of 1 to 2 courses, with adjusted hazard ratios of 4.77 versus 3.33."
This is an indication of the role of the microbial flora in autoimmune disease, and a clear caution to practitioners to be very cautious in prescribing antibiotics for children. Besides the public health issue of antibiotic resistance proliferated by unnecessary prescriptions, there is the loss of tolerance with promotion of autoimmune disorders like inflammatory bowel disease. This study documents a 550% increase in risk for IBD when antibiotics are given to children before the age of one. The authors conclude:
"Childhood antianaerobic antibiotic exposure is associated with IBD development."