Early-life antibiotic exposure: a risk factor for paediatric-onset IBD

Early-life antibiotic intake was associated with an increased risk of paediatric inflammatory bowel disease (IBD) in a Danish, nationwide study. This risk is particularly elevated by repeated prescriptions and broad-spectrum antibiotics.

Using the nationwide health registry in Denmark, Dr Mikkel Malham (Copenhagen University Hospital, Denmark) explored the association between antibiotics during the first 5 years of life and the risk of developing paediatric-onset IBD [1]. “We still do not know exactly why some people develop paediatric-onset IBD. Early-life, environmental factors seem to play a larger role in paediatric-onset IBD than in later-onset IBD,” he explained.

The study included all patients with IBD from 1980 from the nationwide health registry in Denmark who were diagnosed <18 years of age and were followed up through 2018. These patients were matched with up to 10 healthy individuals of the same age, sex, and area of residence. Patients diagnosed before age 6 were excluded to avoid other aetiologies like monogenic causes of IBD.

Overall, 1,808 participants with paediatric-onset IBD (989 Crohn’s disease and 819 ulcerative colitis) and 17,234 matched controls were included in the analysis. Of the participants with IBD, 1,578 had at least 1 prescription of antibiotics from birth to 5 years of age compared with 14,525 prescriptions in the reference individuals.

Over time, the overall risk of developing IBD increased in participants that were prescribed antibiotics during the first 5 years (HR 1.26). “We noticed that mainly Crohn´s disease is associated with increased antibiotics prescriptions,” Dr Malham said. In addition, the risk for IBD was more pronounced in participants who had ≥4 antibiotic prescriptions than in those wo did not (HR 1.43; P<0.0001). The risk for IBD also depended on the specific antibiotic that was prescribed: it was higher for broad-spectrum antibiotics compared with narrow-spectrum antibiotics.

Thus, this study confirms the critical influence of antibiotic prescriptions on the development of paediatric-onset IBD. This association underscores the importance of antibiotic stewardship in public health.

1. Malham M, et al. The impact of early life antibiotics on the occurrence of paediatric inflammatory bowel disease - a nationwide study from 1995 – 2018. DOP20, ECCO 2023, 01–04 March, Copenhagen, Denmark.

Posted on 4 May 20238 April 2024