Does Antibiotic Exposure During Infancy Lead to Development of Asthma?: A Systematic Review and Metaanalysis

doi:10.1378/chest.129.3.610

Chest

Volume 129, Issue 3, March 2006, Pages 610-618

https://doi.org/10.1378/chest.129.3.610 Get rights and content

Objectives

To determine the association between antibiotic exposure in the first year of life and the development of childhood asthma.

Design

Metaanalysis of observational studies retrieved through systematic search of all available electronic data sources. Studies included in the metaanalyses were those with populations exposed to one or more courses of antibiotics during the first year of life, and asthma diagnosis was defined as diagnosis by a physician between the age of 1 to 18 years.

Setting

Retrospective and prospective studies published in the English-language literature from 1966 to present.

Results

Eight studies (four prospective and four retrospective) examined the association between exposure to at least one course of antibiotics and development of childhood asthma. The total number of subjects for the analysis comparing exposure to at least one antibiotic to no exposure in the first year of life was 12,082 children and 1,817 asthma cases. In the dose-response analysis, we included data from a total of 27,167 children and 3,392 asthma cases. The pooled odds ratio (OR) for the eight studies was 2.05 (95% confidence interval [CI], 1.41 to 2.99). The association was significantly stronger in the retrospective studies (OR, 2.82; 95% CI, 2.07 to 3.85) than the prospective studies (OR, 1.12; 95% CI, 0.88 to 1.42). Five of the eight studies examined whether the association was related to the number of courses of antibiotics taken in the first year of life. The overall OR for the dose-response analysis was 1.16 (95% CI, 1.05 to 1.28) for each additional course of antibiotics; however, this association was not significantly stronger in the retrospective studies (OR, 1.37; 95% CI, 1.18 to 1.60) relative to the prospective studies (OR, 1.07; 95% CI, 0.95 to 1.20).

Conclusions

Exposure to at least one course of antibiotics in the first year of life appears to be a risk factor for the development of childhood asthma. Because of the limitations of the studies conducted to date, additional large-scale, prospective studies are needed to confirm this potential association.

Section snippets

Search Strategy

We systematically searched all available electronic databases, including MEDLINE, EMBASE, EBM databases (ACP, Central, CDSR, and DARE), Web of Science, PapersFirst, ProceedingsFirst, and the Cochrane database, for the period January 1966 to September 2004 for all English- and non–English-language articles using the medical subject headings child, childhood, early life or early childhood AND asthma, atopic dermatitis, hay fever, allergic disease, allergy or atopy AND antibiotic, antimicrobial,

Study Selection and Characteristics

Figure 1summarizes the selection process for studies included in the metaanalysis. Our initial search identified 2,056 titles, of which 2,042 were excluded because they either did not investigate an association between antibiotic exposure and childhood asthma or were not in English. Of the 14 remaining articles, we excluded one study¹⁷ that did not exclusively report childhood asthma diagnoses, one study¹⁸ that only examined prenatal antibiotic exposure, three studies that investigated

Discussion

This metaanalysis is the first to address the question of whether antibiotic exposure in the first year of life is associated with the subsequent development of asthma and to address the more specific question of a potential dose-response relationship. Although pooling the results from all of the studies suggests an association between antibiotic exposure and development of asthma (OR, 2.05; 95% CI, 1.41 to 2.99), when the analysis was stratified by the two subtypes of studies (prospective vs

Conclusion

The use of antibacterials in the first year of life is associated with the subsequent development of asthma. However, given the limitations in the methodologic quality of the available epidemiologic studies, further large-scale, database-related studies are needed to conclude whether this association is causal or due to reverse causation.

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Chest

Original Research: ASTHMADoes Antibiotic Exposure During Infancy Lead to Development of Asthma?: A Systematic Review and Metaanalysis

Objectives

Design

Setting

Results

Conclusions

Section snippets

Search Strategy

Study Selection and Characteristics

Discussion

Conclusion

Office visits for otitis media: United States, 1975–90

Adv Data

Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis

JAMA

Disabilities among children aged less than or equal to 17 years: United States, 1991–1992

MMWR Morb Mortal Wkly Rep

Trends in prevalence and severity of childhood asthma

BMJ

Changes in asthma prevalence: two surveys 15 years apart

Arch Dis Child

Prevalence of asthma in Melbourne schoolchildren: changes over 26 years

BMJ

Current estimates from the National Health Interview Survey, 1996

Vital Health Stat

Atopic versus infectious diseases in childhood: a question of balance?

Pediatr Allergy Immunol