Increased Risk of Childhood Asthma From Antibiotic Use in Early Life

Anita L. Kozyrskyj, PhD; Pierre Ernst, MD and Allan B. Becker, MD
From the Faculty of Pharmacy (Dr. Kozyrskyj), University of Manitoba, Winnipeg, MB, Canada; the Division of Clinical Epidemiology (Dr. Ernst), Royal Victoria Hospital, Montreal, QC, Canada; and the Department of Pediatrics and Child Health (Dr. Becker), Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Correspondence to: Anita Kozyrskyj, PhD, 210 Pharmacy Building, Winnipeg, MB, Canada R3T 2N2; e-mail: kozyrsk@cc.umanitoba.ca
Abstract
Background: To address the major methodological issues of reverse causation and selection bias in epidemiologic studies of antibiotic use in early life and the development of asthma, we undertook a cohort study of this association in a complete population of children.
Methods: Using the health-care and prescription databases of Manitoba, Canada, this longitudinal study assessed the association between antibiotic prescription use during the first year of life and asthma at age 7 years in a 1995 birth cohort of 13,116 children.
Results: Independent of well-known asthma risk factors, asthma was significantly more likely to develop in children who had received antibiotics in the first year of life at age 7 years. The association with asthma was observed for antibiotic use in non-respiratory tract infections (adjusted odds ratio [OR], 1.86; 95% confidence interval [CI], 1.02 to 3.37). The risk of asthma was highest in children receiving more than four courses of antibiotics (adjusted OR, 1.46; 95% CI, 1.14 to 1.88), especially among rural children, and in the absence of maternal asthma or a dog in the birth year. Broad-spectrum (BS) cephalosporin use was more common in these subpopulations of children.
Conclusions: Antibiotic use in early life was associated with the development of childhood asthma, a risk that may be reduced by avoiding the use of BS cephalosporins.