Key messages
- Antibiotic use is associated with the risk of chronic inflammatory bowel disease, especially after the age of 40.
- The risk increases with cumulative exposure to antibiotics and is highest in the first two years after exposure.
That the use of antibiotics is a risk factor for chronic inflammatory bowel diseases (IBD, short for inflammatory bowel diseases), or Crohn’s disease and ulcerative colitis, is not a new concept.However, the existence of an association between antibiotics and IBD had so far only been demonstrated in younger subjects. A Danish study published in the journal Gut shows that this association also exists in adults and the elderly. The risk of IBD increases with increasing exposure to antibacterials, although not with all classes of drugs equally.
The study is based on an analysis of national registers of residents of Denmark aged ≥10 years in the period 2000-2018. The cohort analyzed includes more than 6 million people (n = 6,104,245) among whom 52,898 new cases of IBD were diagnosed (36,017 cases of ulcerative colitis and 16,881 cases of Crohn’s disease). During the reporting period, 90.9% of subjects in the cohort were prescribed at least one course of antibiotics. Compared to subjects not exposed to antibiotics, those who were prescribed these drugs had a higher risk of IBD at any age; the relative risk was 1.28 (95%CI 1.25-1.32) in the 10-40 age group, 1.48 (1.43-1.54) in the 40-60 age group and 1.47 (1.42-1.53) in the over 60 age group.This was true for both Crohn’s disease and ulcerative colitis.
The study authors found a dose-response relationship between the number of antibiotic cycles and IBD risk: subjects who received 5 or more courses of antibiotics, in any age group, were those with the highest risk (more than double for those over 40). For all, the risk of developing IBD was higher 1-2 years (40% higher) after exposure to antibiotics than 4-5 years later (13% higher). Distinguishing the various classes of antibiotics, it emerged that the risk was higher with nitromidazoles and fluoroquinolones, drugs commonly prescribed to treat gastrointestinal infections; nitrofurantoin was the only antibiotic not associated with the onset of IBD.
As this is an observational study it is not possible to establish a causal link, however it is reasonable to believe that the effects of antibiotics on the gut microbiome are relevant.»As people age, the changing microbial environment can lead to reduced diversity and increased susceptibility to disturbances. In our study we see possible evidence given that antibiotic use is associated with a higher risk of developing IBD among older people than younger subjects. In addition, with repeated antibiotic cycles, the changes may become more pronounced, ultimately limiting the restoration of the gut microbiota.» Among the reasons to argue the need to reduce the inappropriate use of antibiotics, the doctor should therefore report that doing so reduces the risk of chronic intestinal diseases.
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Source — https://www.univadis.it/viewarticle/antibiotici-e-malattie-infiammatorie-croniche-2023a10000tb