Systematic review and meta-analysis of childhood exposure to antibiotics and the subsequent risk of IBD.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational (cohort and case-control) studies
PubMed 41617205 · doi:10.1093/ibd/izaf324
What was done
A systematic review and meta-analysis was conducted searching MEDLINE and EMBASE through December 31, 2024, for cohort and case-control studies examining antibiotic use during childhood (ages <1 to 17 years) and subsequent risk of inflammatory bowel disease (IBD). Studies reporting hazard ratios, odds ratios, or risk ratios (RR) were pooled using DerSimonian-Laird random-effects models, using adjusted estimates reported in the original studies.
What was found
Ten studies were identified. In pooled analyses of 8 studies (n = 2783 cases), childhood antibiotic exposure versus no exposure was associated with an increased risk of overall IBD (RR, 1.42; 95% CI, 1.23-1.66). In disease-specific analyses including additional studies, antibiotic exposure was associated with Crohn's disease (RR, 1.59; 95% CI, 1.39-1.81) and ulcerative colitis (RR, 1.23; 95% CI, 1.08-1.40). Heterogeneity was low to moderate (I2 = 0%-35%), Egger's test showed no significant publication bias (P = .12-.43), and adjustment for infections did not attenuate the associations.
Why it matters
This review synthesizes observational evidence linking early-life antibiotic exposure to an increased risk of developing IBD, particularly Crohn's disease. It supports the hypothesis that gut microbiome alterations during critical developmental windows may contribute to the pathogenesis of IBD.
Limits
All included studies were observational (cohort and case-control), meaning causality cannot be firmly established. Total participant counts across non-cases are not reported in the abstract. Potential residual confounding by indication (e.g., prodromal gastrointestinal infections or symptoms treated empirically with antibiotics) cannot be completely excluded despite adjustments.
Cited by
- supports Early-life microbiome disruption or depletion increases susceptibility to developing inflammatory bowel disease (IBD) later in life.