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IBD associated with antibiotic use in young infants

Issue: October 2012

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Children aged younger than 12 months may have a significantly increased risk of developing inflammatory bowel disease after being given certain antibiotics, according to a study published online.

Matthew P. Kronman, MD, MSCE, of Seattle Children’s Hospital, and colleagues reported data from 464 ambulatory practices that participated in the United Kingdom’s The Health Improvement Network database.

Fifty-seven percent of the patients received at least one antianaerobic antibiotic for a median of 1 week. In both groups, 0.07% of children developed inflammatory bowel (IBD); however, the IBD incidence rates were 1.52/10,000 person-years in the exposed group compared with 0.83/10,000 per years in those who did not receive antibiotics. The risk decreased with increasing age, Kronman and colleagues wrote.

Antianaerobic antibiotics like penicillin, tetracyclines, clindamycin, cefoxitin, carbapenems and oral vancomycin can kill anaerobic bacteria found in the gut, and the findings show the increased risk of developing IBD, according to Kronman and colleagues.

The researchers hypothesize that inflammation is triggered when there are changes in the gut’s microbiota, which may increase pathogenic bacteria or decrease protective bacteria.

Kronman and colleagues added that many there are still many unanswered questions, including whether specific difficult-to-culture organisms could play roles in either IBD pathogenesis or protection against IBD, and if alteration of flora through antibiotic exposure alters the immune system.

“Antibiotics remain an incredibly important therapy, but we are learning that their use can have significant unintended consequences, including some that are life-long such as inflammatory bowel disease. We must all be more thoughtful prescribers of antibiotics, avoiding them when unnecessary, to prevent both the short- and long-term adverse effects associated with their use,” Kronman told Infectious Disease News. — by Colleen Zacharyczuk

• Kronman MP. Pediatrics. 2012; doi: 10.1542/peds.2011-3886.

Disclosure: Kronman reports no relevant financial disclosures.