Antibiotic use may increase IBS outcomes after colonoscopy
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Patients simultaneously exposed to antibiotics and bowel purgative had slightly higher rates of surrogate irritable bowel syndrome outcomes than matched controls, according to study results.
“For the general population of patients undergoing colonoscopy, the rate of developing IBS after using antibiotics while undergoing bowel preparation is low,” Ravy K. Vajravelu, MD, MSCE, from the division of gastroenterology, hepatology and nutrition, University of Pittsburgh School of Medicine, told Healio Gastroenterology. “In this study, we also explored whether there are subgroups of patients who developed IBS at higher rates. We found that those who were prescribed quinolone antibiotics, such as ciprofloxacin and levofloxacin, around the time of colonoscopy had higher rates of IBS compared with those who were not prescribed them.”
Using data from the Optum’s de-identified Clinformatics Data Mart Database, Vajravelu and colleagues identified 408,714 patients aged 50 years to 55 years who underwent a screening colonoscopy. They matched patients exposed to antibiotics within 14 days of colonoscopy (n = 24,617) with patients who were not exposed to antibiotics near time of colonoscopy. Investigators reported the primary outcome was a new IBS diagnosis and the composite outcome was a new claim for IBS, IBS medications, or IBS symptoms. They used Cox proportional hazards regression to calculate the correlation of antibiotic exposure and outcomes.
Investigators noted there was no statistically significant correlation between antibiotic use and IBS (HR = 1.11; 95% CI, 0.89–1.39). However, there was a weak correlation observed between antibiotic use and the composite outcome (HR = 1.12; 95% CI, 1.02–1.24, number needed to harm 94).
The researchers concluded that, “the population-level impact of antibiotic use around the time of colonoscopy is small, but there may be individuals who are at risk for IBS based on patient and treatment factors.”
In an interview, Vajravelu added, “Because future research is needed to precisely identify which patients are at highest risk for developing IBS from temporary alterations to the gut microbiota, we gastroenterologists should continue to participate in antibiotic stewardship by limiting antibiotic prescriptions to strongly indicated conditions and by encouraging our patients to take an active role in antibiotic prescribing decisions with their other providers.”
Perspective
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Catherine Ly, DO
This study raises the important topic of antibiotic stewardship and educating patients on the potential harms of taking antibiotics unnecessarily. Further studies are needed to identify those patients who are at increased risk of developing IBS after antibiotic exposure.
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