Children, Antibiotics, and Long-Term Health

Antibiotics and Children

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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  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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