Infant antibiotic use and wheeze and asthma risk: a systematic review and meta-analysis

Penders, John; Kummeling, Ischa; Thijs, Carel

doi:10.1183/09031936.00105010

Cited by 128 publications

(121 citation statements)

References 56 publications

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“…On the basis of earlier findings, antibiotic use early in life may alter the normal immune system development in a critical window during which specific subsets of the infant gut microbiota can differentially regulate immune function, leading to an influence on the likelihood of developing atopic disorders (28,29). On the other hand, in contrast with the current survey, a meta-analysis conducted by Pander et al on longitudinal studies indicated that a weak association could exist between antibiotic use and subsequent development of wheeze/asthma over 5 -6 years of age (30). Moreover, the findings of Celedon et al did not support the hypothesis that exposure to antibiotics in the first year of life is related to the later development of asthma, AR, and eczema symptoms or diseases at the age of 5 (31).…”

Section: Discussioncontrasting

confidence: 68%

Evaluation of Allergic Symptoms Prevalence and Its Relationship with Acetaminophen/Antibiotic Use and Hospitalization Among School-Aged Children in Tehran, Iran

Fazlollahi

Abbasi

Dana

et al. 2017

Iran Red Crescent Med J

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Background: Increasing of childhood allergic diseases throughout the world and its heavy socioeconomic burden have posed an important health concern. Therefore, providing the updated relevant epidemiological information is robustly recommended. Objectives: The study aimed to determine the prevalence of asthma, allergic rhinitis (AR), and eczema symptoms in primary school children aged 6 -7 years and ascertain the association of acetaminophen use, antibiotic consumption, and hospitalization for respiratory infection in early life with allergic symptoms. Methods: In this cross-sectional study conducted on primary school children aged 6 -7 years from May to July 2012 in Tehran (Iran), a total of 4993 individuals took part. Cluster sampling was used for random selection of primary schools. Data were gathered by using a modified questionnaire of international study of asthma and allergies in childhood (ISAAC). Then, the questionnaires were completed by parents of the children. Results:The prevalence rates of current wheeze, wheeze ever, current itching rash, itchy rash ever, and rhinitis ever were found to be 19.64%, 27.49%, 8.95%, 8.28%, and 21.87%, respectively. Physician-diagnosed asthma, eczema, and AR were reported in 4.32%, 7.29%, and 9.61% of children, respectively. Univariate logistic regression analysis showed that antibiotic use was significantly associated with symptoms of allergic rhinitis (P = 0.001). Also, the strongest association was found between asthma and atopic dermatitis symptoms and hospitalization due to respiratory infection in early life by multivariate analysis (P = 0.002 and P = 0.009, respectively). Conclusions: This study determined the rising pattern of allergic symptoms in 6 -7 year old children in Tehran. Moreover, acetaminophen/antibiotic use and hospitalization due to respiratory infection in early life were detected as significant risk factors for the appearance of childhood allergic symptoms.

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Section: Discussioncontrasting

confidence: 68%

Evaluation of Allergic Symptoms Prevalence and Its Relationship with Acetaminophen/Antibiotic Use and Hospitalization Among School-Aged Children in Tehran, Iran

Fazlollahi

Abbasi

Dana

et al. 2017

Iran Red Crescent Med J

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“…In a large population-based registry, ÖRTQUIST et al [17] found a positive association between prenatal antibiotic exposure and asthma in the offspring, but these findings were not confirmed in a sibling analysis, indicating a confounding role of shared familial factors. Similarly, two meta-analyses attributed a positive association between antibiotic exposure in infancy and subsequent asthma to confounding factors [30,31].…”

Section: Discussionmentioning

confidence: 99%

Prenatal exposure to antibiotics and wheezing in infancy: a birth cohort study

et al. 2015

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The role of prenatal antibiotic exposure in the development of childhood wheezing is debated. We evaluated whether this association could potentially be explained by confounding factors.Antibiotic use in the first and third trimester of pregnancy, wheezing in children aged ⩽18 months and confounding factors were assessed in singletons participating in the NINFEA (Nascita e Infanzia: gli Effetti dell'Ambiente) birth cohort (n=3530 for first-trimester exposure and n=3985 for third-trimester exposure).There was no evidence of an association between antibiotic exposure in the first trimester of pregnancy and ever-wheezing (adjusted risk ratio (RR) 1.02, 95% CI 0.80-1.30) or recurrent wheezing (RR 0.99, 95% CI 0.54-1.82). For the third-trimester exposure, the crude RRs (95% CI) of ever-wheezing and recurrent wheezing were 1.34 (1.10-1.64) and 2.72 (1.80-4.11), respectively, which decreased to 1.12 (0.90-1.39) and 2.09 (1.32-3.29) after adjustment. The RRs of wheezing after genitourinary infections during pregnancy were increased independently of antibiotic treatment.In conclusion, the association between prenatal antibiotic exposure and infant wheezing could be largely explained by confounding factors, in particular respiratory infections during pregnancy. An excess risk of wheezing after antibiotic exposure during the third trimester of pregnancy remains after adjustment. @ERSpublications Confounders explain increased risk of infant wheeze after antibiotic exposure in the first but not third trimester

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“…Thus, by not having to select for specific microorganisms, as is the case when culture-or hybridization-based approaches are employed, one could generate an overall profile of the impact of antibiotics on infant gut microbiota. While the studies to date are significant, and it is notable that a recent meta-analysis of 18 studies also found a weak positive association between antibiotic use in infancy and asthma and wheeze risk (OR 1.27 95% CI: 1.12-1.43), 177 there are a number of other studies, such as that by Celedon et al that failed to reveal the existence of an association. Similarly in 2007, the Koala Birth Cohort Study of over 2,700 families, once more failed to demonstrate any association between antibiotic use and eczema or asthma risk.…”

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confidence: 89%