The use of broad-spectrum antibiotics during the first year of life may raise the risk of asthma later in childhood, according to the results of a large longitudinal cohort study published in the journal Chest.
“Since oral antibiotics are frequently prescribed for upper and lower respiratory tract infections in children, an understanding of the relation between antibiotic use and asthma is critical to clinicians and health-care policymakers worldwide,” writes Anita L. Kozyrskyj, PhD, from the University of Manitoba in Winnipeg, Canada, and colleagues. “To address the major methodological issues of reverse causation and selection bias in epidemiologic studies of antibiotic use in early life and the development of asthma, we undertook a cohort study of this association in a complete population of children.”
Using the healthcare and prescription databases of Manitoba, Canada, the investigators evaluated the association between antibiotic prescription use during the first year of life and asthma at the age of 7 years in a 1995 birth cohort of 13,116 children.
In children who had received antibiotics in the first year of life, asthma was significantly more likely to develop at the age of 7 years, despite adjustment for well-known asthma risk factors. Children receiving more than four courses of antibiotics had the highest risk for asthma, especially among rural children, in the absence of maternal asthma, or in the absence of a dog during the birth year. In these subpopulations of children, broad-spectrum cephalosporin use was more common.
“Antibiotic use in early life was associated with the development of childhood asthma, a risk that may be reduced by avoiding the use of BS [broad-spectrum] cephalosporins,” the authors write.
The authors note that the strongest evidence against reverse causation in this study is the finding of an association between asthma and antibiotic use for the treatment of non-respiratory-tract infections.
“We can neither confirm nor refute the causative role of antibiotics in the development of asthma,” the authors conclude. “Further large-scale studies are required to determine the longitudinal associations between the composition of intestinal microflora, antibiotic use, and atopic dermatitis during infancy, and the development of asthma in low-risk and high-risk children.
“In the interim, it would be prudent to avoid the unnecessary use broad-spectrum antibiotics in the first year of life when other antibiotics are available.”
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