Early antibiotic use could increase asthma risk in children

There is a possible increased risk of developing asthma for children who receive antibiotics before aged 1 year, according to recent study findings published in The Lancet Respiratory Medicine.

The findings also suggest that impaired viral immunity and genetic variant on chromosome 17 increase the risk of antibiotic use in early life and later development of asthma, instead of just the antibiotics themselves, as previously reported.

No link was found between early antibiotic use and the development of allergic diseases, which contradicts earlier findings that antibiotic use increased susceptibility to allergic asthma later on in life.

Adnan Custovic, DM, MD, PhD, FRCP, of the University of Manchester and University Hospital of South Manchester in the United Kingdom, and colleagues followed 800 children from birth to age 11 years to evaluate information on antibiotic prescription, wheeze and asthma exacerbations. Skin reaction tests were conducted at age 3, 5, 8 and 11 years. Blood was collected at age 11 years from participants who received antibiotics during the first year of life and those who received no antibiotics to compare immune response to viruses (rhinovirus and respiratory syncytial virus) and bacteria (Haemophilus influenzae and Streptococcus pneumoniae). Genetic testing was also performed on chromosome 17 (17q21) to determine links between genetic variations and antibiotic prescription.

Researchers found that participants with wheezing treated by antibiotics during the first year of life were more likely to experience severe wheeze or asthma exacerbations and be hospitalized for asthma compared with untreated participants. Participants treated with antibiotics also had a lower induction of cytokines compared with untreated participants. However, no significant differences were found between the two groups for antibacterial responses.

Two genes from the 17q21 region were also identified as having an association with increased risk of antibiotic prescription early in life.

“We speculate that hidden factors which increase the likelihood of both antibiotic prescription in early life and subsequent asthma are an increased susceptibility to viral infections due to impaired antiviral immunity and genetic variants on 17q21,” Custovic wrote. “However, further studies will be needed to confirm that the impaired immunity was present at the time of the early childhood respiratory symptoms and predated antibiotic prescribing rather than as a consequence of the antibiotics.”

In an accompanying editorial, Julian Crane, MB, BS, FRCP, FRACP, and Kristin Wickens, PhD, of the Wellington School of Medicine and Health Sciences at Otago University in New Zealand, wrote that a randomized trial is required to settle unanswered questions about early antibiotic use being linked to the development of asthma. However, they questioned if it would be feasible.

“This trial would need to be large and would be ethically difficult, but perhaps not impossible, at least not in terms of restricted versus usual antibiotic prescriptions,” they wrote. “In view of the concerns over the rapidly waning efficacy of antibiotics, partly from over prescription, the fact that many are prescribed for disorders that they cannot benefit and the disquiet many parents express about overmedicating their children, the proposal for a randomized control trial is perhaps worthy of some consideration.”

For more information:

Crane J. Lancet Respir Med. 2014;doi:10.1016/S2213-2600(14)70109-2.

Semic-Jusufagic A. Lancet Respir Med. 2014;doi:10.1016/S2213-2600(14)70096-7.

Disclosure: See the study for a full list of disclosures.