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