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Antibiotic exposure and IBD development among children: a population-based cohort study.
Pediatrics. 2012 Oct; 130(4):e794-803.Ped

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.

Authors+Show Affiliations

Division of Infectious Diseases, Seattle Children's Hospital, University of Washington, Seattle, Washington 98105, USA. matthew.kronman@seattlechildrens.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

23008454

Citation

Kronman, Matthew P., et al. "Antibiotic Exposure and IBD Development Among Children: a Population-based Cohort Study." Pediatrics, vol. 130, no. 4, 2012, pp. e794-803.
Kronman MP, Zaoutis TE, Haynes K, et al. Antibiotic exposure and IBD development among children: a population-based cohort study. Pediatrics. 2012;130(4):e794-803.
Kronman, M. P., Zaoutis, T. E., Haynes, K., Feng, R., & Coffin, S. E. (2012). Antibiotic exposure and IBD development among children: a population-based cohort study. Pediatrics, 130(4), e794-803. https://doi.org/10.1542/peds.2011-3886
Kronman MP, et al. Antibiotic Exposure and IBD Development Among Children: a Population-based Cohort Study. Pediatrics. 2012;130(4):e794-803. PubMed PMID: 23008454.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antibiotic exposure and IBD development among children: a population-based cohort study. AU - Kronman,Matthew P, AU - Zaoutis,Theoklis E, AU - Haynes,Kevin, AU - Feng,Rui, AU - Coffin,Susan E, Y1 - 2012/09/24/ PY - 2012/9/26/entrez PY - 2012/9/26/pubmed PY - 2012/12/12/medline SP - e794 EP - 803 JF - Pediatrics JO - Pediatrics VL - 130 IS - 4 N2 - 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. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/23008454/full_citation L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=23008454 DB - PRIME DP - Unbound Medicine ER -