Impact of Long-Term and Low-Dose Antibiotic Prophylaxis on Gut Microbiota in Children.J Urol. 2020 Jul 02 [Online ahead of print]JU
To evaluate the effect of long-term low-dose antibiotic prophylaxis on children's gut microbiota.
MATERIALS AND METHODS
16S ribosomal RNA gene sequencing was conducted using stool samples of 35 infants (median age, 5.2 months; male/female ratio, 17:18) under 3 years old who underwent antibiotic treatment during the acute phase of febrile urinary tract infection (fUTI). Samples were collected at five timepoints: before, during, and at 1-2, 3-4, and 5-6 months after fUTI onset and antibiotic treatment. Continuous antibiotic prophylaxis (CAP) using trimethoprim-sulfamethoxazole (TMP-SMX CAP) was initiated in 23 cases with vesicoureteral reflux (VUR) of grade III or higher (CAP group), and CAP was not performed in the 12 cases without VUR (non-CAP group).
Within two weeks after fUTI treatment initiation, almost all enteric bacteria belonged to the order Lactobacillales, and gut microbiota diversity decreased compared to the pretreatment level (average Shannon index: pre, 2.9; during, 1.4). The diversity recovered within 1-2 months after fUTI onset in both groups; diversity was maintained during the study period in both groups (p = 0.43). Fewer proportion of gut microbiota component belonged to the order Enterobacteriales (p = 0.002) in the CAP group.
Our results showed that CAP-treated patients had normal gut microbiota diversity, indicating that the effect of TMP-SMX CAP on gut microbiota was insignificant. Furthermore, TMP-SMX CAP might selectively suppress the growth of bacteria belonging to the order Enterobacteriales, such as Escherichia coli and Klebsiella spp., which are the main causative bacteria of fUTI.