Antibiotic Exposure Associated with Development of Inflammatory Bowel Disease

Hold off on using antibiotics unless truly needed, says Seattle Children’s researcher


Children who receive antibiotics may be more likely to develop inflammatory bowel disease, according to a new study led by Matthew Kronman, MD, of Seattle Children’s Hospital.  The study, “Antibiotic exposure and IBD development among children: A population-based cohort study,” was published September 24 in Pediatrics.

Dr. Kronman and researchers from Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania analyzed data from more than one million patients in 464 ambulatory practices in the United Kingdom.  The team found 748 of these patients developed IBD.

Kids and Inflammatory Bowel Disease

About seven out of 100,000 children develop IBD each year in the United States.  Most people diagnosed with IBD get it when they are 15 to 35 years old. But some children as young as three to four years old get IBD. It tends to run in families.

Researchers do not completely understand what causes IBD, a chronic intestinal inflammatory condition that includes Crohn’s disease and ulcerative colitis.  About 20 percent of people with either Crohn’s disease or ulcerative colitis have a close relative with some form of IBD.  Previous studies have suggested associations between antibiotic use and IBD development, but these studies were limited by incomplete information on antibiotics or lack of controls.

How Antibiotics Work

“When you take an antibiotic, it changes the populations of bacteria that normally live in your gut,” said Kronman, who works in the division of Infectious Diseases at Seattle Children’s Hospital.  “The change either gets rid of healthy, protective bacteria or may alter the ones that are there to be more inflammation-causing.”

Dr. Kronman said the study findings echo the warnings of infectious disease experts.  “Do not use antibiotics if you don’t need them,” he said.

How do the across-the-pond findings extrapolate to the United States?  “Physicians in the U.K., which has a national health system, are generally more judicious in the use of antibiotics than we are,” said Dr. Kronman.  “We use all of the same antibiotics in the United States and we may even use more of them, so we might see even more cases in IBD associated with antibiotic use here.”

Antibiotic Use, Prescriptions in the United States

According to the study, an estimated 49 million outpatient pediatric antibiotic prescriptions—approximately one-half for penicillins—occur in the United States annually.  Data suggest those prescriptions would be associated with 1,700 additional IBD cases yearly.

What’s next for the researchers?  Dr. Kronman said that his work at Children’s will focus on ways to improve how providers prescribe antibiotics.  And scientists will investigate how intestinal bacteria may actually cause IBD.

If you’d like to arrange an interview with Dr. Kronman, please contact the Children’s PR team at 206-987-4500 or at [email protected].