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Published online March 2, 2009
PEDIATRICS Vol. 123 No. 3 March 2009, pp. 1003-1010 (doi:10.1542/peds.2008-1146)
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ARTICLE

Antibiotic Use in Children Is Associated With Increased Risk of Asthma

Fawziah Marra, PharmDa,b, Carlo A. Marra, PharmD, PhDa,c, Kathryn Richardson, MSca,c, Larry D. Lynd, BSP, PhDa,c, Anita Kozyrskyj, BScPhm, PhDd, David M. Patrick, MD, MHSca,b, William R. Bowie, MDa, J. Mark FitzGerald, MDa,e

a Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
b Department of Vaccine and Pharmacy, BC Centre for Disease Control, Vancouver, British Columbia, Canada
c Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
d Department of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada
e Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada

BACKGROUND. Antibiotic exposure in early childhood is a possible contributor to the increasing asthma prevalence in industrialized countries. Although a number of published studies have tested this hypothesis, the results have been conflicting.

OBJECTIVE. To explore the association between antibiotic exposure before 1 year of age and development of childhood asthma.

METHODS. Using administrative data, birth cohorts from 1997 to 2003 were evaluated (N = 251817). Antibiotic exposure was determined for the first year of life. After the first 24 months of life, the incidence of asthma was determined in both those exposed and not exposed to antibiotics in the first 12 months of life. Cox proportional hazards models were used to adjust for potential confounders and determine the hazard ratios associated with antibiotic exposure for the development of asthma.

RESULTS. Antibiotic exposure in the first year of life was associated with a small risk of developing asthma in early childhood after adjusting for gender, socioeconomic status at birth, urban or rural address at birth, birth weight, gestational age, delivery method, frequency of physician visits, hospital visit involving surgery, visits to an allergist, respirologist, or immunologist, congenital anomalies, and presence of otitis media, acute, or chronic bronchitis, and upper and lower respiratory tract infections during the first year of life. As the number of courses of antibiotics increased, this was associated with increased asthma risk, with the highest risk being in children who received >4 courses. All antibiotics were associated with an increased risk of developing asthma, with the exception of sulfonamides.

CONCLUSIONS. This study provides evidence that the use of antibiotics in the first year of life is associated with a small risk of developing asthma, and this risk increases with the number of courses of antibiotics prescribed.

Key Words: asthma • antibiotics • epidemiology • children • pediatrics

Abbreviations: HR—hazard ratio • CI—confidence interval • BC—British Columbia • SES—socioeconomic status • ATC—Anatomical Therapeutic Chemical Classification System • ICD-9—International Classification of Diseases, Ninth Revision • URTI—upper respiratory tract infection • LRTI—lower respiratory tract infection • MSP—medical services plan • PY—person-years • OR—odds ratio

Accepted Jul 18, 2008.


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