- There may be a dose-dependent relationship between number of antibiotic courses and development of IBD.
- Risk appears greater among frequent broad-spectrum antibiotic users because of gut microbiota effect.
- Related editorial .
Why this matters
- Antibiotic stewardship is important not only for reducing resistance but also because it might attenuate or prevent the increase in dysbiosis-related chronic diseases.
- 23,982 patients (15,951 ulcerative colitis; 7898 Crohn’s disease; 133 unspecified), 117,827 control participants.
- IBD risk (aORs; 95% CIs) among antibiotic users:
- 1.88 (1.79-1.98) for incident IBD;
- 1.74 (1.64-1.85) for ulcerative colitis;
- 2.27 (2.06-2.49) for Crohn’s disease.
- Multivariate: ≥3 antibiotic dispensations >1 year before IBD diagnosis increased IBD risk:
- aOR, 1.55 (95% CI, 1.49-1.61).
- Slightly higher risk seen with Crohn’s.
- Risk estimates similar for 2-year vs 1-year lead-n;
- Multivariate aOR for ≥3 dispensations vs none: 1.47 (P<.0001>
- Broad-spectrum antibiotics use linked to higher risk vs narrow-spectrum (P<.0001 all conditions>
- Use of siblings as reference group slightly attenuated risk estimates vs general population control participants, ≥3 dispensations (multivariate aOR, 1.35; P<.0001>
- Prospective Swedish national case-control pharmacoepidemiological study assessing link between cumulative antibiotic use and IBD.
- Funding: NIH, others.
- Use data uncaptured.
- Unmeasured confounding.
- Limited generalizability.
- Reverse causation possible.