Antibiotic use can promote inflammatory bowel disease in childhood

The use of antibiotics demands great care and discrimination. A paper just published in Gut, An International Journal of Gastroenterology & Hepatology offers further evidence that disruption of the microbial ecology can promote autoimmune disorders. The authors state:

"The composition of the intestinal microflora has been proposed as an important factor in the development of inflammatory bowel diseases (IBD). Antibiotics have the potential to alter the composition of the intestinal microflora. A study was undertaken to evaluate the potential association between use of antibiotics and IBD in childhood."

They examined all Danish singleton children born from 1995 to 2003 (577,627 children) for correlations between antibiotic prescriptions and IBD while taking into consideration potential confounding variables. They then calculated rate ratios (RRs) of IBD according to antibiotic use. Their data painted a compelling picture:

"IBD was diagnosed in 117 children during 3,173,117 person-years of follow-up. The RR of IBD was 1.84 for antibiotic users compared with non-users. This association appeared to be an effect on Crohn's disease (CD) alone (RR 3.41) and was strongest in the first 3 months following use (RR 4.43) and among children with ≥7 courses of antibiotics (RR 7.32)."

In other words, there was an 84% increase in IBD for antibiotic users versus non-users. The increase in Crohn's disease was particularly dramatic—341% in general, 443% in the first 3 months after antibiotic use, and a whopping 732% for children who had seven or more courses of antibiotics. The authors conclude:

"Antibiotic use is common in childhood and its potential as an environmental risk factor for IBD warrants scrutiny. This is the first prospective study to show a strong association between antibiotic use and CD in childhood."

While, as the authors concede, an observational study does not establish causality, prudence dictates that care be taken in evaluating each patient for propensities to autoimmune disorders, and to apply appropriate pro- and prebiotic support during and after antimicrobial therapy.