Childhood Antibiotic Use Linked to Higher Risk of Inflammatory Bowel Disease: Meta-Analysis Finds
Norway: A systematic review and meta-analysis published in Inflammatory Bowel Diseases has found that antibiotic exposure during childhood is associated with an increased risk of developing inflammatory bowel disease (IBD), particularly Crohn’s disease. The findings suggest that early antibiotic use may have lasting effects on gut health by disrupting the developing microbiome.
Antibiotics are widely prescribed in childhood, especially during the early years when the gut microbiome is still forming. Increasing evidence indicates that environmental factors, including microbial alterations, may contribute to the development of IBD. To better understand this relationship, Ketil Størdal and colleagues from the Department of Pediatric Research, Faculty of Medicine, University of Oslo, conducted a systematic review of existing studies examining antibiotic exposure in childhood and the subsequent risk of IBD.
For this purpose, the researchers conducted a comprehensive search of the MEDLINE and EMBASE databases from their inception through December 31, 2024. They included both cohort and case-control studies that evaluated antibiotic exposure from infancy through adolescence (before age 18) and reported IBD risk outcomes. Measures such as hazard ratios, odds ratios, or risk ratios were considered for analysis. To address variability across studies, pooled estimates were calculated using a random-effects model, with adjustments made for confounding factors as reported in the original studies.
The analysis included 10 studies, of which 8 contributed to the primary pooled analysis, encompassing 2,783 IBD cases. Additional studies focusing specifically on Crohn’s disease and ulcerative colitis were also included in subgroup analyses.
The study led to the following findings:
- Children exposed to antibiotics had a significantly higher risk of developing inflammatory bowel disease (IBD) compared to those without exposure.
- Overall, antibiotic use was associated with a 42% increased risk of IBD.
- The risk was higher for Crohn’s disease, with a 59% increase observed among antibiotic-exposed children.
- Ulcerative colitis also showed an increased risk, though comparatively lower, at 23%.
- The findings were consistent across studies, with low to moderate heterogeneity reported.
- Statistical analyses did not show evidence of significant publication bias.
- Adjusting for underlying infections did not meaningfully alter the results.
- This suggests that the increased risk of IBD may be more directly related to antibiotic exposure rather than the infections for which antibiotics were prescribed.
The authors also noted that earlier exposure to antibiotics and repeated courses appeared to be associated with a higher risk, although these patterns require further investigation. These findings align with the hypothesis that disruption of the gut microbiome during critical developmental periods may influence immune regulation and increase susceptibility to chronic inflammatory conditions.
While the study does not establish a direct causal relationship, it reinforces concerns about the long-term impact of early antibiotic use. The findings highlight the importance of cautious and judicious prescribing of antibiotics in children, balancing immediate clinical needs with potential future health risks such as IBD.
Reference:
Størdal, K., Andersen, S., Mårild, K., Larsson, V., & Imberg, H. Systematic review and meta-analysis of childhood exposure to antibiotics and the subsequent risk of IBD. Inflammatory Bowel Diseases. https://doi.org/10.1093/ibd/izaf324
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