October 8, 2014
Early Use of Broad-Spectrum Antibiotics Linked toPhiladelphia—Early use of broad-spectrum antibiotics could increase the risk that infants and young toddlers will develop obesity over the next few years, according to a new report.
The study, led by researchers from Children's Hospital of Philadelphia, warns that use of the powerful antibiotics before 24 months of age was associated with increased risk of obesity in early childhood.
Authors of the study, published recently in JAMA Pediatrics, say they embarked on the research because previous studies suggested that obesity, a major public health problem, could be affected by intestinal microflora which are, in turn, impacted by antibiotic exposure.
For the study, researchers used 2001-2013 electronic health records from a network of primary care clinics, focusing on 64,580 children with annual visits at ages 0 to 23 months, as well as one or more visits at ages 24 to 59 months. The children were tracked until they reached 5 years of age.
According to the results, 69% of the children were exposed to antibiotics before the age of 24 months, with an average exposure of 2.3 episodes per child.
The increased risk of obesity was associated with more extensive antibiotic use, especially for children with four or more exposures, when either a range of antibiotics or only broad-spectrum antibiotics were examined.
“Cumulative exposure to antibiotics was associated with later obesity (rate ratio [RR], 1.11; 95% CI, 1.02-1.21 for ≥4 episodes); this effect was stronger for broad-spectrum antibiotics (RR, 1.16; 95% CI, 1.06-1.29),” according to the results. “Early exposure to broad-spectrum antibiotics was also associated with obesity (RR, 1.11; 95% CI, 1.03-1.19 at 0-5 months of age and RR, 1.09; 95% CI, 1.04-1.14 at 6-11 months of age) but narrow-spectrum drugs were not at any age or frequency.”
The results also indicate that steroid use, male sex, urban practice, public insurance, Hispanic ethnicity, and diagnosed asthma or wheezing were stronger predictors of obesity, while common infectious diagnoses and anti-reflux medications were not.
For the study group, the prevalence of obesity was 10% at age 2 years, 14% at 3 years, and 15% at 4 years. The prevalence of being either overweight or obese was 23%, 30%, and 33%, respectively.
“Because obesity is a multifactorial condition, reducing prevalence depends on identifying and managing multiple risk factors whose individual effects may be small but modifiable,” according to the authors. “Our results suggest that the use of broad-spectrum outpatient antibiotics before age 24 months may be one such factor.”
The researchers also posit that their study “provides additional support for the adoption of treatment guidelines for common pediatric conditions that emphasize limiting antibiotic use to cases where efficacy is well demonstrated and preferring narrow-spectrum drugs in the absence of specific indications for broader coverage.”
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