Q&A: Understanding link between antibiotic use, childhood asthma through microbiome

Key takeaways:

• A study is set to determine how antibiotics impact airway and gut microbiome development in infants.
• This will provide context to the link between infant antibiotic use and childhood asthma.

The link between antibiotic use in infancy and childhood asthma has been investigated, revealing a higher risk for asthma with antibiotics, but there remains a question of how the microbiome underlies this, according to a press release.

Christian Rosas-Salazar, MD, MPH, assistant professor of pediatrics, allergy, immunology and pulmonary medicine at Monroe Carell Jr. Children’s Hospital at Vanderbilt, and colleagues are set to assess this question in a 5-year study by determining how antibiotics impact airway and gut microbiome development in infants.

According to the release from Vanderbilt University Medical Center, they also hope to uncover specific bacterial species and their function that change with antibiotic use and to explain the association between infant antibiotic use and childhood asthma development.

Healio spoke with Rosas-Salazar to learn more about the study, its design and the risk for childhood asthma after infant antibiotic use.

Healio: What inspired the creation of this 5-year study?

Rosas-Salazar: There are no interventions to prevent asthma in children. Multiple studies have suggested that the use of antibiotics in the first year of life can increase the risk for developing asthma during childhood. If we understand the precise mechanisms that explain how infant antibiotic use can lead to childhood asthma, then maybe we can create interventions to prevent this common chronic lung disease.

Healio: What are some reasons for antibiotic use in individuals from birth to age 1 year?

Rosas-Salazar: Antibiotics are among the most used medications in infants worldwide and can be a life-saving intervention in those with bacterial infections. They are used for bacterial infections of different body sites, such as ear, throat, lung and urinary tract infections. Unfortunately, it is sometimes difficult to differentiate viral and bacterial infections in young children, so sometimes antibiotics are incorrectly prescribed in early life.

Healio: How common is infant antibiotic use and what is the risk for developing childhood asthma associated with infant antibiotic use? Are there studies that have assessed these specific questions?

Rosas-Salazar: It has been previously estimated that approximately 35% to 50% of children are exposed to antibiotics in the first 12 months of life in the U.S.

In one meta-analysis by William Murk, MPH, and colleagues, children exposed to antibiotics in the first year of life had approximately 80% higher odds of developing childhood asthma between ages 3 to 18 years than those not exposed to antibiotics.

Healio: You are hoping to find a safe way to deliver antibiotics to infants that lessens the risk for childhood asthma. How does the design of the study allow you to investigate this?

Rosas-Salazar: Our study will use prospective data and samples (including respiratory and stool samples collected throughout the first year of life) from children enrolled in several birth cohorts across the U.S. and novel laboratory and biostatistical methods to look at the specific bacteria or bacterial patterns that are impacted by using antibiotics in the first year of life, and how changes in these bacteria or bacterial patterns can increase the risk for developing asthma during childhood. Once we know the pathways explaining the association of infant antibiotic use with childhood asthma, then our goal is to design an intervention that can modify the microbiome to prevent childhood asthma development.

Healio: Could you provide more detail about how probiotics might play a role in this study?

Rosas-Salazar: There are no probiotics currently approved to reduce the need for antibiotics or to prevent childhood asthma. We hope that the results of our study will help us design a microbiome-based intervention (such as probiotics) aimed to deliver antibiotics safely during early life and reduce the burden of childhood asthma.

Healio: You are looking at the use of antibiotics in infancy and its impact on asthma. Do you have plans to investigate the use of antibiotics during pregnancy and its impact on childhood asthma?

Rosas-Salazar: This is an important question, and we hope to use the infrastructure and resources from the current study to address this question in future projects.

References:

• Murk W, et al. Pediatrics. 2011;doi:10.1542/peds.2010-2092.
• Study to explore antibiotics role in childhood asthma. https://news.vumc.org/2024/11/13/study-to-explore-antibiotics-role-in-childhood-asthma/. Published Nov. 13, 2024. Accessed Nov. 19, 2024.

For more information:

Christian Rosas-Salazar, MD, MPH, can be reached at c.rosas.salazar@vumc.org.