Another study adds weight to the idea that early antibiotic use may increase the risk of developing inflammatory bowel disease (IBD) (J Pediatr 2013; 162: 510-4).
Using a nested case-control design, the authors matched 2377 controls to 294 children with IBD in a population-based database from Manitoba, Canada. Specifically, the authors looked at the frequency of otitis media diagnosis and the likelihood of subsequent IBD. By age 5 years, 89% of IBD cases had at least one diagnosis of otitis media, compared with 82% of the controls. Despite the high frequency in both groups, the authors determined that individuals with a diagnosis of otitis media before age 5 years were 2.8-fold more likely to be an IBD case.
Some of the strengths of this study included the fact that it was a population-based analysis dating back to 1984 and likely captured almost all pediatric IBD cases (<19 years). Nearly all physicians in Manitoba submit billing claims to a single publicly funded source. Due to the nature of administrative data, this eliminates recall bias.
However, administrative data have several limitations as well. Other confounding conditions may have been present and not identified; this could include family history and autoimmune diseases.
The authors “suspect” that the linkage between otitis media and IBD relates to the usage of antibiotics and subsequent alterations of the intestinal microflora. Otitis media may serve as a “sensitive proxy measure” of antibiotic use. Also, as boys are more frequently treated for otitis media, this may relate to the generally higher incidence of pediatric IBD in males.
For anyone interested in the association between antibiotic exposure and IBD, this study is useful and provides a number of references as well.
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