We’re surrounded by bacteria– literally. They live on the surface our skin and set up camp in our intestines immediately after birth. The complexity of the colonies that live there diversifies throughout our lives–many sticking around for the duration. And we’re dependent on the ka-billions of bacteria that co-exist with us to maintain our health. Without them, things can go off-kilter as bacteria really are a part of our wellness–supporting digestion and maintaining harmony on our skin. Of course, some bacteria come in that we’d really rather not have. That’s when we use antibiotics.

As cough and cold season returns, a study published today serves up a needed reminder. Antibiotics can cause significant changes to our body. Because many infections are caused by viruses (not bacteria) antibiotics are often unnecessary. When we take antibiotics by mouth (or IV/injection) they may kill the bacteria causing a troubling or painful infection yes, but they can also kill the desired “good bacteria,” too. This is a side effect all antibiotics carry. Often we witness this in our children by changes in their poop—after a course of antibiotics they get really runny poop or diarrhea or it will smell entirely different. You really are witnessing the change of colonies in their intestines when you see this.

Sometimes antibiotics are absolutely necessary and life-saving. But recent research has found that antibiotics are prescribed in 1 out of 5 pediatric acute-care visits. And of the 49 million prescriptions for antibiotics given annually, some researchers estimate that 10 million of those are unnecessary. Avoiding those unnecessary courses is up to all of us–parents and clinicians.

I really do think the tide is changing in this regard. It’s rare that a family requests or urges for antibiotics in clinic.

New research is looking at how altering bacteria in our bodies may change our life-long health. It’s not just the alteration in our poop immediately after antibiotics that changes. A new study shows antibiotic use may set us up for chronic disease. And this may be especially true when antibiotics are used in infants and young children.

Research Finds Antibiotics May Be Associated With IBD Diagnosis

  • Dr Matthew Kronman and colleagues studied over 1 million patient records in the UK. They evaluated the infant and childhood exposures to certain antibiotics and the later development of Inflammatory Bowel Disease (IBD). The causes of IBD are incompletely understood; Dr Kronman wanted to understand if bacterial changes in the intestines at young ages affected inflammation that could potentially increase the likelihood of being diagnosed with IBD (Crohn’s disease or Ulcerative Colitis). They studied medical charts of a huge group of patients to determine if children prescribed common oral antibiotics in outpatient clinics (penicillin, amoxicillin, Augmentin, clindamycin, metronidazole, for example) had increased rates of IBD later in life.
  • They studied over 1 million patient charts. Of those 1M, 748 children developed inflammatory bowel disease.
  • Infants given antibiotics had the highest increase in IBD risk: with each antibiotic course, a 6% increase in getting IBD occurred. Infants who had more than 2 courses in their infancy had higher risk than those with just one course. The effect appears slightly cumulative–the more doses, the higher the risk.
  • Children getting antibiotics before age 5 years and 15 years also had increased risk for IBD, but less so than the infants treated with antibiotics.
  • IBD is fairly rare. Here’s how Dr Kronman explained the numbers (and risks) to me:

While there was a high increase in relative risk of IBD between those who were prescribed antibiotics and those who were not (84% overall), the ABSOLUTE risk of IBD is actually quite small in any given person (1 out of 10,000 or so developed IBD in the study, comparable with rates published in other studies). So yes, there was a 6% increased IBD risk with each course of antibiotics, because .000106 is 6% higher than .000100, but these risks are small on an individual level.

 Tips For Parents

  • The results don’t mean your child will have bowel problems if they’ve had penicillin. The causes of IBD are complex and not perfectly understood–family history and other auto-immune conditions also put children at risk. This data simply helps remind us that each medication we give our children has both benefit and risk.
  • Whenever antibiotics are prescribed for your child, ask if they are necessary. Inquire about alternative treatment plans. Discuss the possibility of using probiotics (“good bacteria” capsules and packets) concurrent with antibiotics if you have to use them. Spoonful of Bacteria for Baby? Read about research and information about probiotics and infants
  • Don’t ever treat your child with old, unused antibiotics from the cupboard.
  • Don’t use antibacterial soap at home — there is no evidence its necessary or more effective at keeping our children healthy and there is some evidence these soaps change patterns of bacteria resistance.
  • Avoiding Antibiotics Whenever Possible –blog post about “over-prescribing” & tips for using antibiotics from Healthy Children

What do you think? Do you work to avoid antibiotics when you can? Or have you had the opposite experience—have you had to push for antibiotics in a way that made you uncomfortable?