Frequent antibiotics may bump IBD risk by as much as 55%

  • Nguyen LH & al
  • Lancet Gastroenterol
  • 18.08.2020

  • von Liz Scherer
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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>

Study design

  • Prospective Swedish national case-control pharmacoepidemiological study assessing link between cumulative antibiotic use and IBD.
  • Funding: NIH, others.

Limitations

  • Use data uncaptured.
  • Unmeasured confounding.
  • Limited generalizability.
  • Reverse causation possible.