Research published online in the journal Nature suggests that regular antibiotic use may increase the risk of inflammatory bowel disease — Crohn’s disease and ulcerative colitis — in adults over 40. Intestine.
The findings suggest that the risk appears to be cumulative and is greatest for 1-2 years after use and for those antibiotics that target intestinal infections.
Mounting evidence shows that environmental factors potentially implicated in the development of inflammatory bowel disease (IBD). Globally, nearly 7 million people have the condition, and this number is expected to grow over the next decade, researchers say.
To explore this further, the researchers collected national health data from 2000 to 2018 on Danish citizens aged 10 years and older who had not been diagnosed with IBD. They specifically wanted to know whether the timing and dose of antibiotics could be important for the development of IBD and whether this varied with IBD and the type of antibiotic.
More than 6.1 million people were included in the study, just over half of them female. In total, 5.5 million (91%) were prescribed at least one course of antibiotics between 2000 and 2018. During this period, approximately 36,017 new cases of the disease were reported. ulcerative colitis and 16,881 newly diagnosed cases of Crohn’s disease.
Overall, compared with no antibiotic use, the use of these drugs was associated with a higher risk of IBD, regardless of age. But older age is associated with the highest risk.
People between the ages of 10-40 are 28% more likely to be diagnosed with IBD; People 40-60 years old are 48 percent more likely to receive this diagnosis, while those over 60 are 47 percent more likely to have it.
The risk of Crohn’s disease is slightly higher than for ulcerative colitis: 40% in 10-40 year olds; 62% are aged 40-60; and 51% of those over 60 years old.
Risk appears to be cumulative, with each subsequent course adding 11%, 15% and 14% higher risk, by age group.
The highest risk was observed in those prescribed 5 or more courses of antibiotics: 69% high risk for 10-40 year olds; the risk doubles for those 40-60 years old; and the risk increased 95% for people over 60 years old.
Timing also seems to have an effect, with the highest risk of IBD occurring 1-2 years after antibiotic exposure, with each subsequent year thereafter being associated with a reduced risk.
Specifically, between the ages of 10-40, the risk of IBD was 40% higher in the 1-2 years after taking antibiotics compared with 13% in the 4-5 years afterwards. The equivalent figure for 40-60 year olds is 66% versus 21% and for those over 60 it’s 63% vs 22%.
As for antibiotics, the highest risk of IBD is associated with nitroimidazoles and fluoroquinolones, which are commonly used to treat intestinal infections. They are called broad-spectrum antibiotics because they indiscriminately target all bacteria, not just those that cause disease.
Nitrofurantoin was the only antibiotic not associated with IBD risk at any age.
Narrow-spectrum penicillins are also associated with IBD, although to a much lesser extent. This adds weight to the notion that changes in the gut microbiome may play an important role and that many antibiotics have the potential to alter the composition of bacteria in the gut.
This was an observational study, and therefore, cause cannot be established; The researchers note that there is also no information on the intended uses of these drugs or the number of patients who have actually taken them.
But there are several plausible biological explanations for these findings, they suggest, highlighting a natural decline in both the resilience and range of bacteria in gut microbiota associated with aging, with which antibiotic use is likely to be associated.
“Furthermore, with repeated courses of antibiotics, these changes may become more pronounced, ultimately limiting gut microbiota recovery,” they added.
They conclude: “The association between antibiotic exposure and the development of IBD underscores the importance of antibiotic management as a public health measure and reveals the gastrointestinal microbiome. is an important factor in the development of IBD, especially in older adults.”
Antibiotic use as a risk factor for inflammatory bowel disease in all ages: a population-based cohort study, Intestine (2023). DOI: 10.1136/gutjnl-2022-327845
British Medical Journal
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