Tuesday, January 10, 2023

Antibiotics and Bowel Disorders

Frequent use of antibiotics can increase the risk of developing microbiome-associated diseases in all age groups.

Studies have shown that antibiotic exposure in the prenatal period and during the first 2 years of life can significantly impact the risk of developing atopic and metabolic disorders later in life. The first 6 months of life appeared to be a critical period, as this is when the microbiome is most susceptible to irreversible changes. 

Studies of older children (such as 11,000 teens and pre-teens from Finland) have found that, instead of a specific age, the frequency of antibiotic use in the two years prior to the diagnosis of autoimmune disorders, was more strongly associated with risk. Exposures to cephalosporins, macrolides, and amoxicillin-clavulanic acid throughout childhood seemed to increase the likelihood of Juvenile Arthritis (JIA). Exposures to macrolides within two years before diagnosis showed minor association with other autoimmune disorders, including type 1 diabetes (DM), autoimmune thyroiditis (AIT), JIA, and inflammatory bowel diseases (IBD)). 

An article recently accepted for publication found that frequent use of antibiotics later in life also increased the risk of IBD. This study of more than 6 million individuals followed for close to 20 years analyzed 87112328 person-years including 36017 new cases of ulcerative colitis (UC) and 16881 new cases of Crohn’s disease (CD) - two primary types of IBD with different characteristics. This risk was predominantly driven by those diagnosed with CD and was strongest within the first few months of antibiotic use. In a nationwide case–control study of individuals 16-years or older in Sweden, similar results were seen for three or more antibiotic dispensations.

The authors of the study hypothesized that antibiotics contribute to the development of IBD by modulating the intestinal microbiome, but more research is needed to fully understand the mechanism behind this association.


Semeh Bejaoui, Michael Poulsen, The impact of early life antibiotic use on atopic and metabolic disorders: Meta-analyses of recent insights, Evolution, Medicine, and Public Health, Volume 2020, Issue 1, 2020, Pages 279–289, https://doi.org/10.1093/emph/eoaa039

Räisänen L, Kääriäinen S, Sund R, Engberg E, Viljakainen H, Kolho KL. Antibiotic Exposures and the Likelihood of Developing Pediatric Autoimmune Diseases: a Register-based Matched Case-control Study. (2021). DOI: 10.21203/rs.3.rs-1110501/v1

Faye AS, Allin KH, Iversen AT, et al Antibiotic use as a risk factor for inflammatory bowel disease across the ages: a population-based cohort study Gut Published Online First: 09 January 2023. doi: 10.1136/gutjnl-2022-327845