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Antibiotics - Beware Overuse!

Given my previous role as the medical director of a rural ER, and with it the position of physician liaison for our Antibiotics Stewardship Program, I found this article to be intriguing. It reinforces the need for the judicious use of antibiotics in ALL populations but especially in the pediatric population, especially given unfolding news and research associated with the gut microbiome and how it can be negatively impacted by the overuse of antibiotics. This is not the perfect study showing that antibiotic use leads to childhood obesity (remember: correlation does not equal causation) but it is refreshing to see studies like this in the news. -Dr. Floyd

Repeated antibiotic exposure in early childhood is associated with an increased likelihood of obesity and a higher mean BMI, according to results from a New Zealand study published in JAMA Network Open.

“This research provides additional evidence, alongside increasing antibiotic resistance, for improved antibiotic stewardship,” Cameron C. Grant, FRACP, PhD, head of the department of child and youth health and professor of pediatrics at the University of Auckland in New Zealand, told Healio. “This association between antibiotic exposure and obesity and BMI in this study is fairly generalizable to singletons with a gestation age of 28 weeks or more and without congenital anomalies.”

Grant and colleagues examined antibiotic exposure, age at first antibiotic exposure, number of antibiotic dispensings and timing of exposures between birth and age 48 months in 5,128 singletons. They collected antibiotic dispensing data via the New Zealand Pharmaceutical Collection database, with WHO BMI-for-age z scores and International Obesity Task Force overweight and obesity cutoff points as primary outcomes.

Only singletons with 54-month height and weight measurements, no congenital anomalies, a gestational age of more than 27 weeks and community antibiotic dispensing and birth weight data were included in the study.

Of the children analyzed, 95% had an antibiotic prescription by age 48 months and 9% had obesity at 54 months. Adjusted average BMI-for-age z scores increased significantly with four to six (z = 1.06), seven to nine (z = 1.06) and more than nine (z = 1.08) antibiotic dispensings. Receipt of more than nine dispensings also was associated with a greater likelihood of obesity compared with no antibiotic exposures (aOR = 2.41; 95% CI, 1.07-5.41).

“It should be feasible, as Chelimo et al. suggest, to study whether randomized interventions to reduce overprescribing of antibiotics have an additional benefit of reducing the incidence of childhood obesity,” Meghan B. Azab, PhD, assistant professor of pediatrics and child health at the University of Manitoba, and Arthur Owora, DrPH, assistant professor of epidemiology and biostatistics at Indiana University, Bloomington, wrote in an accompanying editorial. “Meanwhile, both antibiotic stewardship programs and childhood obesity prevention programs are clearly needed, although it remains to be seen whether and how these initiatives might converge.”

Grant noted that limitations of the study included the use of self-reported maternal weight, the inability to obtain maternal BMI and gestational weight gain data from medical records and the lack of complete data on household income. Grant also said further research regarding antibiotic overuse is warranted.

“Antibiotics have many benefits to human health in treating infections caused by bacteria,” he said. “However, there is concern regarding the overuse or unnecessary use of antibiotics and the potential consequences of this. Future research could examine whether interventions such as antibiotic stewardship programs, which are designed to reduce overprescribing of antibiotics, also reduce early childhood obesity.”


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