Higher cumulative exposure to systemic antibiotic therapy, particularly broader spectrum antibiotics, may be associated with a greater risk of new-onset inflammatory bowel disease (IBD) and its subtypes, suggests a prospective case-control study in The Lancet Gastroenterology & Hepatology.
Through the Epidemiology Strengthened by histoPathology Reports in Sweden (ESPRESSO) study, researchers identified 23,982 new patients with IBD (15,951 ulcerative colitis, 7898 Crohn's disease, 133 unclassified IBD) diagnosed over a 10-year period (2007-2016), and compared them with 117,827 matched controls and 28,732 siblings. Conditional logistic regression was used to estimate multivariable-adjusted odds ratios (aOR) and 95% CIs for diagnosis of incident IBD.
After adjusting for several risk factors, aOR in patients who had used antibiotics versus those who had never used antibiotics was 1.88 (95% CI 1.79–1.98) for diagnosis of incident IBD, 1.74 (1.64–1.85) for ulcerative colitis, and 2.27 (2.06–2.49) for Crohn's disease.
The data showed that aOR was higher in patients who had received one antibiotic dispensation (1.11, 1.07–1.15), two antibiotic dispensations (1.38, 1.32–1.44), and three or more antibiotic dispensations (1.55, 1.49–1.61) than patients who had none.
Increased risk was noted for ulcerative colitis (aOR with three or more antibiotic dispensations 1.47, 95% CI 1.40–1.54) and Crohn's disease (1.64, 1.53–1.76) with higher estimates corresponding to use of antibiotics with a greater spectrum of microbial coverage.
Similar but attenuated results were observed when siblings were used as the reference group, with an aOR of 1.35 (95% CI 1.28–1.43) for patients who had received three or more dispensations, compared with general population controls.
“Our findings, if substantiated by longer-term prospective studies in humans or mechanistic preclinical investigations, suggest the need to further emphasise antibiotic stewardship to prevent the rise in dysbiosis-related chronic diseases, including IBD,” the researchers said.