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Although rates have declined in recent years, antibiotic use in children remains high; clinicians prescribed 67 million to US children in 2013.^1,2 A growing body of evidence reveals early-life antibiotic use can have long-term consequences. In one study, the impact of antibiotic exposure in the first two years of life was studied in five-year-old children in Japan.³ Antibiotics were a risk factor for asthma, atopic dermatitis, and rhinitis in these children.³

Taking an antibiotic alters the gut microbiome,^4,5 and these changes can last for years. An analysis using metagenomics and purchase records found that antibiotics, specifically macrolides, used in two- to six-year-old Finnish children were associated with a long-lasting shift in microbiota composition.⁶ Actinobacteria levels decreased while Bacteroidetes and Proteobacteria increased.⁶ Other studies have correlated decreased Actinobacteria in early life, paired with multiple courses of antibiotics, with later-life obesity.⁷ Effects of macrolides on children were long lasting in that the microbiota of the test subjects did not return to the level of control samples over two years.⁶ Macrolide-treated children were also more likely to be overweight and to have asthma.⁶ Interestingly, penicillin did not show the same risk factors or microbiome impacts,⁶ suggesting that the type of antibiotic is an important consideration.

Shifts or alterations in the microbiota can have many effects, potentially including a higher risk of obesity.⁸ A great deal of research has established a link between antibiotic use and childhood obesity; one meta-analysis involving 445,880 participants concluded that early-life antibiotics increase obesity risk.⁹ Early-life, repeated courses of antibiotics have been correlated with increased later-life risks for asthma,³ obesity,⁸ and Crohn’s disease.⁹

The overwhelming consensus that pediatric antibiotic use plays a causative role in immune-based and metabolic conditions both in childhood and later life suggests that we should be very judicious in prescribing them.

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References

1. Fleming-Dutra KE, Demirjian A, Bartoces M, Roberts RM, Taylor TH Jr, Hicks LA. Variations in antibiotic and azithromycin prescribing for children by geography and specialty – United States, 2013 [published online July 19, 2017]. Pediatr Infect Dis J. doi:10.1097/INF.0000000000001708.
2. Frenk SM, Kit BK, Lukacs SL, Hicks LA, Gu Q. Trends in the use of prescription antibiotics: NHANES 1999-2012. J Antimicrob Chemother. 2016;71(1):251-256. doi:10.1093/jac/dkv319.
3. Yamamoto-Hanada K, Yang L, Narita M, Saito H, Ohya Y. Influence of antibiotic use in early childhood on asthma and allergic diseases at age 5. Ann Allergy Asthma Immunol. 2017;119(1):54-58. doi:10.1016/j.anai.2017.05.013.
4. Yallapragada SG, Nash CB, Robinson DT. Early-life exposure to antibiotics, alterations in the intestinal microbiome, and risk of metabolic disease in children and adults. Pediatr Ann. 2015;44(11):e265-269. doi:10.3928/00904481-20151112-09.
5. Keeney KM, Yurist-Doutsch S, Arrieta MC, Finlay BB. Effects of antibiotics on human microbiota and subsequent disease. Annu Rev Microbiol. 2014;68:217-235. doi:10.1146/annurev-micro-091313-103456.
6. Korpela K, Salonen A, Virta LJ, et al. Intestinal microbiome is related to lifetime antibiotic use in Finnish pre-school children. Nat Commun. 2016;7:10410. doi:10.1038/ncomms10410.
7. Korpela K, Zijlmans MAC, Kuitunen M, et al. Childhood BMI in relation to microbiota in infancy and lifetime antibiotic use. Microbiome. 2017;5(1):26. doi:10.1186/s40168-017-0245-y.
8. Shao X, Ding X, Wang B, et al. Antibiotic exposure in early life increases risk of childhood obesity: a systematic review and meta-analysis. Front Endocrinol. 2017;8:170. doi:10.3389/fendo.2017.00170.
9. Virta L, Auvinen A, Helenius H, Huovinen P, Kolho KL. Association of repeated exposure to antibiotics with the development of pediatric Crohn’s disease—a nationwide, register-based Finnish case-control study. Am J Epidemiol. 2012;175(8):775-784. doi:10.1093/aje/kwr400.

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