Kusel MMH, de Klerk N, Holt PG, Sly PD. Clin Exp Allergy. 2008;38(12):1921–1928
PURPOSE OF THE STUDY. To investigate an association with antibiotic use in the first year of life and subsequent development of atopic disease in the first 5 years of life.
STUDY POPULATION. A prospective birth cohort of 198 children considered to be at high atopic risk was recruited prenatally and monitored for 5 years. Risk was based on ≥1 parent with a doctor's diagnosis of asthma, hay fever, or eczema.
METHODS. Parents kept a daily diary of their child's symptoms, including history of respiratory illnesses, and antibiotic use. The study physician evaluated children at regular intervals for the presence of eczema, and annual interviews took place, during which parents reported a diagnosis of asthma or wheezing. At 5 years of age, all children underwent skin-prick testing and gave serum samples for measurement of total immunoglobulin E. To determine the effect of antibiotic use on future atopic disease, a logistic regression model was used with propensity score adjustment, with adjustments for a calculated antibiotic predictor score, number of doctor visits, gender, child care, and pets.
RESULTS. Fifty-four percent of the children (107 of 198 children) received ≥1 course of antibiotics in the first year of life. Acute respiratory illness, and in particular lower respiratory illness, was the most common reason for use of antibiotics. Children who received antibiotics for wheezing lower respiratory illness between 7 and 12 months were more likely to be diagnosed with asthma (odds ratio [OR]: 3.1 [95% confidence interval (CI): 1.2–7.3]; P < .05). Asthma in general was associated with antibiotic use (unadjusted OR: 2.3 [95% CI: 1.2–4.5]; P = .01), but this association was reduced (OR: 1.4 [95% CI: 0.7–3.0]) with propensity score adjustment. There were no associations between antibiotic use and eczema, current wheeze, current asthma, atopic asthma, allergic rhinoconjunctivitis, or atopy (defined as a positive skin-prick test result or elevated total immunoglobulin E level).
CONCLUSIONS. In a cohort of children at high risk, there were no associations of antibiotic use in the first year of life with later development of atopic disease.
REVIEWERS COMMENTS. As the interest of the general public in an anthroposophic lifestyle increases, providers continue to have a responsibility to provide optimal care, which includes prescribing antibiotics when they are clinically indicated in the interest of preserving the greater health of the child. Despite a small sample size and lack of randomization, this study reinforces that early antibiotic use is not associated with increased development of atopy. However, children with atopy, particularly asthma, may be more likely to receive antibiotics in the first year of life.
- Copyright © 2009 by the American Academy of Pediatrics