Antibiotic use elevates IBD risks in senior citizens

An analysis including 2.3 million individuals older than 60 years showed that the use of antibiotics – independent of class – is associated with an increased risk of older-onset inflammatory bowel disease (IBD). Moreover, a positive dose-response was observed where multiple courses of antibiotics were associated with a higher risk.

In the real-world analysis presented by Prof. Adam S. Faye (NYU Langone Health, NY, USA), 2.3 million individuals aged 60 to 90 years were included and followed from 2000 to 2018 [1]. Prof. Faye and his colleagues used data from a nationwide registry in Denmark to assess the impact of cumulative antibiotic use, the timing of antibiotic use, and the association between specific antibiotic classes and the development of older-onset IBD.

From 2000 to 2018, 10,773 new cases of ulcerative colitis and 3,825 new cases of Crohn's disease were identified with diagnostic ICD-10 codes. Any antibiotic use was associated with a 64% higher risk of developing IBD (incidence rate ratio [IRR] 1.64). All antibiotic classes elevated the risk for IBD development, including those not used to treat a gastrointestinal infection. However, the risk differed between classes and was highest when fluoroquinolones (IRR 2.27), nitroimidazoles (IRR 2.21), and macrolides (IRR 1.74) were used. Moreover, there was a clear dose-response observed: 1 course of antibiotics was associated with an IRR of 1.27, 2 courses with an IRR of 1.54, going up to ≥5 courses with a staggering IRR of 2.35. Effect estimates were slightly higher for Crohn’s disease versus ulcerative colitis. The risk of developing late-onset IBD was highest in the first 1–2 years after antibiotic use but remained elevated for 5 years.

"Inflammatory bowel disease often can be overlooked in older adults because there's a lot of different diagnoses you're thinking of," said Prof. Faye. "It should be considered, especially if you have a patient reporting that they had multiple courses of antibiotics within the past few years." Prof. Faye pointed out that, while antibiotic stewardship is essential, "avoiding antibiotics at all costs is not the right answer either. If patients are coming in with clear infections and they need antibiotics, they should not be withheld because of these findings," he concluded.

1. Faye AS, et al. Antibiotics as a risk factor for older-onset IBD: population-based cohort study. Lecture 400, Digestive Disease Week 2022, 21–24 May, San Diego, CA, USA.

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Posted on 14 June 20228 April 2024