Number of antibiotic dispensations potentially linked with IBD development
Higher cumulative exposure to systemic antibiotic therapy may be associated with higher risk for the development of inflammatory bowel disease, according to research published in Lancet Gastroenterology & Hepatology.
Jonas F. Ludvigsson, MD, of the department of medical epidemiology and biostatistics at Karolinska Institutet in Sweden, and colleagues wrote that learning how environmental and other factors impact the development of IBD is critical.
“Globally, rates of IBD are rising, particularly in areas undergoing rapid economic development,” they wrote. “Since these trends are unlikely to be explained by drastic changes in underlying genetic architecture, the widespread adoption of increased sanitation and pervasive use of anti-infective agents is implicated.”
Researchers identified patients with IBD in Sweden with IBD (n = 23,982) and compared them with 117,827 control individuals matched on the basis of age, sex, county and calendar year. They also used a secondary control group of unaffected 28,732 siblings. Investigators obtained data on patients’ cumulative antibiotic dispensations until 1 year before matching.
After adjusting for risk factors, Ludvigsson and colleagues found that antibiotic use was associated with a diagnosis of IBD (aOR = 1.88; 95% CI, 1.79–1.98) compared with no antibiotic use. The association was stronger with a diagnosis of Crohn’s disease (aOR = 2.27; 95% CI, 2.06–2.49) than ulcerative colitis (aOR = 1.74; 95% CI, 1.64–1.85).
The association increased as the number of antibiotic dispensations went up, from one dispensation (aOR = 1.11; 95% CI, 1.07–1.15) to three or more dispensations(aOR = 1.55; 95% CI, 1.49–1.61) compared with patients who had none.
Researchers found similar results when they used their sibling control group, although the association was somewhat smaller (aOR = 1.35; 95% 1.28–1.43).
“The relationship between antimicrobial treatment and IBD was not materially altered when predisposed siblings were used as the referent controls,” Ludvigsson and colleagues wrote. “Further studies are needed to investigate how antibiotics might permanently alter gut microbial communities, potentially culminating in disease development, and whether that risk could be reduced by probiotics to prevent expansive blooms of pathogenic bacteria in place of beneficial microbes affected by antibiotic treatment.”