Multiple penicillin courses may modestly lower risk for Parkinson disease, reveals research
Researchers have reported that early exposure to a few antimicrobials, like penicillins and antifungals, could impact the risk for Parkinson's disease (PD) in later life. A new study of the Clinical Practice Research Datalink (CPRD) data reported an association where people exposed to higher courses of penicillins had reduced PD risk but those who had multiple antifungal prescriptions had a minor increase in PD risk. The study was conducted by Gian Pal and colleagues and was published in the journal Parkinsonism and Related Disorders.
Parkinson's disease is a complex neurodegenerative disorder influenced by genetic and environmental factors, but its relationship with prior antimicrobial exposure remains unclear. This study, conducted using a UK-representative population, analyzed whether exposure to different antimicrobials affected the likelihood of developing PD.
The nested case-control study design was carried out with a sample sourced from CPRD. For this study, researchers analyzed data sourced from CPRD for 12,557 cases of PD and controls matched to them, 80,804 controls. Controls and PD cases were matched one to one based on age, sex, and year of diagnosis, the index date. It reviewed prescribed courses of antimicrobials up to 1–5, 6–10, and 11–15 years before diagnosis. Logistic regression models using generalized estimating equations were applied in order to compute ORs and consider false discovery.
• Those exposed to five or more courses of penicillin 1-5 years before the index date showed a 15% reduction in the odds of developing PD (OR 0.85; 95% CI 0.76–0.95, p = 0.043).
• A comparable hazard was observed 6–10 years earlier: those who had the same regimen of penicillin had a 16% hazard reduction for PD compared with matched controls (OR 0.84; 95% CI 0.73–0.95, p = 0.059).
• The association persisted 11–15 years before diagnosis but was not significant (OR 0.87; 95% CI 0.74–1.02, p = 0.291).
• A small, non-significant reduction in the risk of PD was found to be associated with macrolide treatment courses taken 1–5 years prior to diagnosis (ORs between 0.89–0.91; 95% CI 0.79–0.99, adjusted p = 0.140–0.167).
• This cohort had an increased risk of PD by 16% (OR 1.16; 95% CI 1.06–1.27, p = 0.020).
Overall, this large analysis speaks to a more subtle relationship between antimicrobial exposure and the risk of PD. Specifically, penicillin exposure may convey slightly lower risk for disease, whereas antifungal exposure slightly increases the risk. Such studies highlight the fact that long-term effects of antimicrobial exposure on neurodegenerative diseases should be considered.
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