Antibiotic exposure and IBD development among children: a population-based cohort study.

TitleAntibiotic exposure and IBD development among children: a population-based cohort study.
Publication TypeJournal Article
Year of Publication2012
AuthorsKronman MP, Zaoutis TE, Haynes K, Feng R, Coffin SE
JournalPediatrics
Volume130
Issue4
Paginatione794-803
Date Published2012 Oct
ISSN1098-4275
KeywordsAnti-Bacterial Agents, Bacteria, Anaerobic, Carbapenems, Cefoxitin, Child, Child, Preschool, Clindamycin, Cohort Studies, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Great Britain, Humans, Incidence, Inflammatory Bowel Diseases, Logistic Models, Male, Metronidazole, Penicillins, Proportional Hazards Models, Retrospective Studies, Risk, Tetracycline, Vancomycin
Abstract

OBJECTIVE: To determine whether childhood antianaerobic antibiotic exposure is associated with the development of inflammatory bowel disease (IBD).

METHODS: This retrospective cohort study employed data from 464 UK ambulatory practices participating in The Health Improvement Network. All children with ≥ 2 years of follow-up from 1994 to 2009 were followed between practice enrollment and IBD development, practice deregistration, 19 years of age, or death; those with previous IBD were excluded. All antibiotic prescriptions were captured. Antianaerobic antibiotic agents were defined as penicillin, amoxicillin, ampicillin, penicillin/β-lactamase inhibitor combinations, tetracyclines, clindamycin, metronidazole, cefoxitin, carbapenems, and oral vancomycin.

RESULTS: A total of 1072426 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 1.52/10000 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 (95% confidence interval [CI]: 1.66-18.28) but decreased to 2.62 (95% CI: 1.61-4.25) and 1.57 (95% CI: 1.35-1.84) by 5 and 15 years, respectively. Each antibiotic course increased the IBD hazard by 6% (4%-8%). 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 (95% CI: 2.13-10.68) versus 3.33 (95% CI: 1.69-6.58).

CONCLUSIONS: Childhood antianaerobic antibiotic exposure is associated with IBD development.

DOI10.1542/peds.2011-3886
Alternate JournalPediatrics
PubMed ID23008454
PubMed Central IDPMC4074626
Grant ListT32-HD043021 / HD / NICHD NIH HHS / United States
U18HS016946 / HS / AHRQ HHS / United States
UL1-RR024134 / RR / NCRR NIH HHS / United States