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. 2021 Mar 3;5(1):e001028.
doi: 10.1136/bmjpo-2021-001028. eCollection 2021.

Early life antibiotics and childhood gastrointestinal disorders: a systematic review

Kim Kamphorst #  1   2 , Emmy Van Daele #  3 , Arine M Vlieger  2 , Joost G Daams  4 , Jan Knol  3   5 , Ruurd M van Elburg  1
Affiliations

Early life antibiotics and childhood gastrointestinal disorders: a systematic review

Kim Kamphorst et al. BMJ Paediatr Open. .

Abstract

Background: In adults, there is increasing evidence for an association between antibiotic use and gastrointestinal (GI) disorders but in children, the evidence is scarce.

Objective: Assess the association between exposure to antibiotics in the first 2 years of life in term born children and the presence of chronic GI disorders later in childhood.

Design: For this systematic review the MEDLINE, Embase, WHO trial register and Web of Science were systematically searched from inception to 8 June 2020. Title and abstract screening (n=12 219), full-text screening (n=132) as well as the quality assessment with the Newcastle-Ottawa Scale were independently performed by two researchers.

Main outcome measures: The association between antibiotics and inflammatory bowel disease (IBD) (n=6), eosinophilic oesophagitis (EoE) (n=5), coeliac disease (CeD) (n=6), infantile colics (n=3), functional constipation (n=2), recurrent abdominal pain, regurgitation, functional diarrhoea and infant dyschezia were examined.

Results: Twenty-two studies were included, 11 cohort and 11 case-control studies. A best evidence synthesis showed strong evidence for an association between antibiotic exposure in the first 2 years of life and the presence of IBD, and CeD during childhood. Moderate evidence was found for an association with EoE and no association with functional constipation in the first year of life. There was insufficient evidence for the other studied disorders.

Conclusions: The use of antibiotics in early life may increase the risk of GI disorders later in life. Further studies are necessary to unravel the underlying mechanisms and determine potential preventive measures. Meanwhile judicious use of antibiotics in early childhood is highly warranted.

Prospero registration number: PROSPERO CRD42019132631.

Keywords: epidemiology; gastroenterology; neonatology.

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Conflict of interest statement

Competing interests: JK is a fulltime employee of Danone Nutricia Research (DNR), the PhD trajectory of EVD and KK are partly sponsored by DNR.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram of the study selection.
Figure 2
Figure 2
Forest plots per gastrointestinal disorder. (A) IBD; (B) EoE; (C) CeD; (D) FGID (infantile colics and functional constipation). CC, case control study, CH, cohort study, (!) Virta 2012 only shows the results of the phenoxymethylpenicillin analyses, overall use of antibiotics was not significant.
See this image and copyright information in PMC

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