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Ann Allergy Asthma Immunol. 2014 May;112(5):441-445.e1. doi: 10.1016/j.anai.2014.01.022. Epub 2014 Mar 13.

Consequences of antibiotics and infections in infancy: bugs, drugs, and wheezing.

Author information

1
Australian Institute for Health Innovation, University of New South Wales, Sydney, Australia; Children's Hospital Informatics Program at Harvard-MIT Health Sciences and Technology, Boston Children's Hospital, Boston, Massachusetts.
2
Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
3
Children's Hospital Informatics Program at Harvard-MIT Health Sciences and Technology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Center for Biomedical Informatics, Harvard Medical School, Boston, Massachusetts. Electronic address: Kenneth_Mandl@harvard.edu.

Abstract

BACKGROUND:

The prevalence of asthma has increased alarmingly in the past 2 to 3 decades. Increased antibiotic use in infancy has been suggested to limit exposure to gastrointestinal microbes and to predispose to asthma in later life.

OBJECTIVE:

To evaluate the association between antibiotic exposure during the first year of life and the development of asthma up to the age of 7 years.

METHODS:

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, in the United States (n = 62,576). We evaluated the association between antibiotic exposure during the first year of life and subsequent development of 3 asthma phenotypes: transient wheezing (began and resolved before 3 years of age), late-onset asthma (began after 3 years of age), and persistent asthma (began before 3 years of age and persisted through 4-7 years of age).

RESULTS:

Antibiotic use in the first year of life was associated with the development of transient wheezing (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.9-2.2; P < .001) and persistent asthma (OR, 1.6; 95% CI, 1.5-1.7; P < .001). A dose-response effect was observed. When 5 or more antibiotic courses were received, the odds of persistent asthma doubled (OR, 1.9; 95% CI, 1.5-2.6; P < .001). There is no association between antibiotic use and late-onset asthma.

CONCLUSION:

Antibiotic use in the first year life is associated with an increased risk of early-onset childhood asthma that began before 3 years of age. The apparent effect has a clear dose response. Heightened caution about avoiding unnecessary use of antibiotics in infants is warranted.

PMID:
24631182
DOI:
10.1016/j.anai.2014.01.022
[Indexed for MEDLINE]

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