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Meta-Analysis
. 2021 Jan-Dec;13(1):1-18.
doi: 10.1080/19490976.2020.1870402.

Association between antibiotics and gut microbiome dysbiosis in children: systematic review and meta-analysis

Lucy McDonnell  1 , Alexander Gilkes  1 , Mark Ashworth  1 , Victoria Rowland  1 , Timothy Hugh Harries  1 , David Armstrong  1 , Patrick White  1
Affiliations
Meta-Analysis

Association between antibiotics and gut microbiome dysbiosis in children: systematic review and meta-analysis

Lucy McDonnell et al. Gut Microbes. 2021 Jan-Dec.

Abstract

Antibiotics in childhood have been linked with diseases including asthma, juvenile arthritis, type 1 diabetes, Crohn's disease and mental illness. The underlying mechanisms are thought related to dysbiosis of the gut microbiome. We conducted a systematic review of the association between antibiotics and disruption of the pediatric gut microbiome. Searches used MEDLINE, EMBASE and Web of Science. Eligible studies: association between antibiotics and gut microbiome dysbiosis; children 0-18 years; molecular techniques of assessment; outcomes of microbiome richness, diversity or composition. Quality assessed by Newcastle-Ottawa Scale or Cochrane Risk of Bias Tool. Meta-analysis where possible. A total of 4,668 publications identified: 12 in final analysis (5 randomized controlled trials (RCTs), 5 cohort studies, 2 cross-sectional studies). Microbiome richness was measured in 3 studies, species diversity in 6, and species composition in 10. Quality of evidence was good or fair. 5 studies found a significant reduction in diversity and 3 a significant reduction in richness. Macrolide exposure was associated with reduced richness for twice as long as penicillin. Significant reductions were seen in Bifidobacteria (5 studies) and Lactobacillus (2 studies), and significant increases in Proteobacteria such as E. coli (4 studies). A meta-analysis of RCTs of the effect of macrolide (azithromycin) exposure on the gut microbiome found a significant reduction in alpha-diversity (Shannon index: mean difference -0.86 (95% CI -1.59, -0.13). Antibiotic exposure was associated with reduced microbiome diversity and richness, and with changes in bacterial abundance. The potential for dysbiosis in the microbiome should be taken into account when prescribing antibiotics for children.Systematic review registration number: CRD42018094188.

Keywords: Antibiotics; Children; Gut dysbiosis.

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Figures

Figure 1.
Figure 1.
PRISMA flow chart. Preferred reporting items for systematic reviews and meta-analyses 2009
Figure 2.
Figure 2.
Meta-analysis of trials of azithromycin that used Shannon Index of microbiome alpha diversity as the outcome
See this image and copyright information in PMC

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