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May 29, 2014
Antibiotic Use in Infancy Raises Persistent Asthma Risk

Boston—Pharmacists and other health professionals should caution about the unnecessary use of antibiotics in the first year of life, according to a new Boston Children’s Hospital study that links use with early-onset childhood asthma.

Background in the study, published recently in the journal Annals of Allergy, Asthma and Immunology, notes that the prevalence of asthma has increased significantly in the past 2 to 3 decades. Previous research has raised questions about whether antibiotic use in infancy limits exposure to gastrointestinal microbes, predisposing babies to asthma later in life, according to the authors.

The researchers sought to evaluate the association between antibiotic exposure during the first year of life and the development of asthma up to the age of 7 years.

The retrospective population-based study focused on a cohort of 62,576 children enrolled in a nationwide employer-provided health insurance plan from January 1, 1999, through December 31, 2006, in the United States.

Researchers evaluated the association between antibiotic exposure during the first year of life and subsequent development of three asthma phenotypes: transient wheezing beginning and resolving before age 3; late-onset asthma, beginning after 3 years of age; and persistent asthma, beginning before age 3 and persisting through 4 to 7 years of age.

Results indicate that antibiotic use in the first year of life was associated with the development of transient wheezing (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.9-2.2; P < .001) and persistent asthma (OR, 1.6; 95% CI, 1.5-1.7; P < .001).

Researchers observed a dose-response effect, the odds of persistent asthma doubling when five or more antibiotic courses were received.

No association was noted between antibiotic use and late-onset asthma.

“Antibiotic use in the first year life is associated with an increased risk of early-onset childhood asthma that began before 3 years of age,” the authors write. “The apparent effect has a clear dose response. Heightened caution about avoiding unnecessary use of antibiotics in infants is warranted.”





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