Antibiotic Exposure Linked with Development of IBD in Children

Investigators retrospectively examined the association between antibiotic exposure and the development of inflammatory bowel disease (IBD) in children (age range, ≤17 years) in 464 general practices (>3 million active patients) in a population-based database representing about 5.7% of U.K. patient visits.

Antianaerobic antibiotics were defined as penicillin, amoxicillin, ampicillin, and penicillin/ß-lactamase inhibitor combinations, as well as tetracyclines, clindamycin, metronidazole, cefoxitin, carbapenems, and oral vancomycin. Patients were classified as ever (64%) or never exposed to a course of antibiotics. Antibiotic exposure during the latency period between the onset of IBD and formal diagnosis (when patients might receive antibiotics for symptoms arising from as-yet undiagnosed IBD) were excluded in the analysis regardless of outcome to address potential misclassification bias.

The analysis included data on 1,072,426 children, 748 (0.07%) of whom developed IBD. IBD incidence rates were 0.83 and 1.52 per 10,000 person-years in unexposed and exposed children, respectively (adjusted hazard ratio, 5.51; 95% confidence interval, 1.66–18.28). Any antianaerobic antibiotic exposure was significantly associated with developing IBD in a dose-response manner. Each antianaerobic course increased the risk for IBD by 6%. Results for patients with Crohn disease and ulcerative colitis were similar to the overall results.