Early Use of Antibiotics Tied to an Increased Risk of Pediatric Asthma

By: Fatima Elzin, PharmD Candidate c/o 2015

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According to the Centers for Disease Control and Prevention, the prevalence of asthma has risen dramatically in the past two to three decades.¹ In the United States, 6.8 million children were diagnosed with asthma in 2012.¹ Recent data suggests that this increase in children with asthma may be correlated with the early use of antibiotics.  More specifically, children treated with antibiotics before their first birthday were associated with a heightened risk of asthma and the risk increases the more often antibiotics are prescribed.²

A retrospective population based study of a cohort of children, enrolled in a nationwide employer-provided health insurance plan from January 1, 1999 through December 31, 2006, evaluated the association between antibiotic use during the first year of life and subsequent development of asthma.³ The main objective was to examine the link between antibiotic use in the first year of life and the development of transient wheezing (started and resolved before 3 years of age), late-onset asthma (after 3 years of age), and/or persistent asthma (started before 3 years of age and persisted through 4-7 years of age).

The data included medical insurance claims for approximately 1.6 million children, and consisted of 62,576 children who were enrolled from birth through at least age 5. The results of this study concluded that 18.5% of children (about 1 in 5) developed wheezing or asthma between infancy and age 7.³ The prevalence of the three types of asthma reflected these results: 5,460 cases (8.7%) were transient, 6,418 (10.3%) were late-onset, and 5,946 (9.5%) were persistent. According to the study, around 26,693 children (42.7%) had been through at least one course of antibiotic therapy during their first year of life.³

Ultimately, researchers concluded that the use of antibiotics in the first year of life was linked to transient wheezing (odds ratio [OR] 2.0, 95% CI 1.9-2.2, P<0.001) and an increased risk of persistent asthma (OR 1.6, 95% CI 1.5-1.7, P<0.001).³ The associations remained even after excluding patients who experienced at least one episode of lower or upper respiratory tract infection (19.4% and 44%, respectively) and/or asthma.³ The results from this study supported the “hygiene and microbiota hypotheses” which states that decreased exposure during childhood leads to an increased risk of atopic disease in childhood.²

Unfortunately, the study did not take into consideration other factors that may increase the risk of asthma in children. Other risks such as where the patient lives (rural or urban), family smoking, and vaginal or c-section birth may cause changes in the data presented.² The study does not directly prove that antibiotic use causes asthma, since other factors in the child’s life may cause asthma as well, but serves as a precaution to doctors to only prescribe antibiotics in children when it is absolutely necessary.

SOURCES:

1. FastStats- Asthma. Centers for Disease Control and Prevention. http://www.cdc.gov/nchs/fastats/asthma.htm. July 14, 2014. Accessed January 1, 2015.
2. Ong MS, Umetsu DT, Mandl KD. Consequences of antibiotics and infections in infancy: bugs, drugs, and wheezing. Ann Allergy Asthma Immunol. 2014;112(5):441-445.e1.
3. Smith M. Asthma risk up with early antibiotic use. Medpage. http://www.medpagetoday.com/Pediatrics/Asthma/45759. Sept 15, 2014. Accessed January 1, 2015.