Antibiotics Tied to Pediatric Inflammatory Bowel Disease

Penicillin, tetracyclines, and several other common antibiotics may lead to inflammatory bowel disease (IBD) in children, according to a new study.

Researchers at the University of Washington (Seattle, USA), The Children’s Hospital of Philadelphia (CHOP; PA, USA), and Seattle Children's Hospital (WA, USA) conducted a retrospective cohort study involving 1,072,426 subjects from 464 ambulatory practices in the United Kingdom participating in the Health Improvement Network to determine whether childhood antianaerobic antibiotic exposure is related with the development of IBD. The researchers reviewed data on all children with over two years of follow-up between practice enrollment and IBD development, practice deregistration, 19 years of age, or death; all antibiotic prescriptions were captured.

The results showed that IBD incidence rates among antianaerobic antibiotic unexposed and exposed subjects were 0.83 and 1.52 per 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 one year of age had an adjusted hazard ratio of 5.51, but decreased to 2.62 by 5 years and 1.57 by 15 years. The researchers found that a dose-response effect existed, with receipt of more than antibiotic courses more highly associated with IBD development; each antibiotic course increased the IBD hazard by 6%. The study was published in the October 2012 issue of Pediatrics.

“Results were similar for the two IBD categories of Crohn's disease and ulcerative colitis,” concluded lead author Matthew Kronman, MD, of Seattle Children's Hospital, and colleagues. “One might expect such infections to be primarily gastrointestinal, yet only 1.6% of antibiotic prescriptions to our subjects who developed IBD were for gastrointestinal infections, and excluding these subjects from analysis did not change our results.”

The researchers cautioned that reverse causality was a possibility, with erroneous IBD diagnosis timing causing the association, so that some patients could have received antianaerobic antibiotics for treatment of undiagnosed IBD.

Related Links:
University of Washington
The Children’s Hospital of Philadelphia
Seattle Children's Hospital