Dose, Timing, and Type of Infant Antibiotic Use and the Risk of Childhood Asthma

Author:

Donovan Brittney M1ORCID,Abreo Andrew1,Ding Tan2,Gebretsadik Tebeb2,Turi Kedir N1,Yu Chang2,Ding Juan3,Dupont William D2,Stone Cosby A1,Hartert Tina V1,Wu Pingsheng12

Affiliation:

1. Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee

2. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee

3. Department of School of Mathematics and Statistics, Guangxi Normal University, Guilin, China

Abstract

Abstract Background Aspects of infant antibiotic exposure and its association with asthma development have been variably explored. We aimed to evaluate comprehensively and simultaneously the impact of dose, timing, and type of infant antibiotic use on the risk of childhood asthma. Methods Singleton, term-birth, non–low-birth-weight, and otherwise healthy children enrolled in the Tennessee Medicaid Program were included. Infant antibiotic use and childhood asthma diagnosis were ascertained from prescription fills and healthcare encounter claims. We examined the association using multivariable logistic regression models. Results Among 152 622 children, 79% had at least 1 antibiotic prescription fill during infancy. Infant antibiotic use was associated with increased odds of childhood asthma in a dose-dependent manner, with a 20% increase in odds (adjusted odds ratio [aOR], 1.20 [95% confidence interval {CI}, 1.19–1.20]) for each additional antibiotic prescription filled. This significant dose-dependent relationship persisted after additionally controlling for timing and type of the antibiotics. Infants who had broad-spectrum-only antibiotic fills had increased odds of developing asthma compared with infants who had narrow-spectrum-only fills (aOR, 1.10 [95% CI, 1.05–1.19]). There was no significant association between timing, formulation, anaerobic coverage, and class of antibiotics and childhood asthma. Conclusions We found a consistent dose-dependent association between antibiotic prescription fills during infancy and subsequent development of childhood asthma. Our study adds important insights into specific aspects of infant antibiotic exposure. Clinical decision making regarding antibiotic stewardship and prevention of adverse effects should be critically assessed prior to use during infancy.

Funder

Agency for Healthcare Research and Quality

National Institutes of Health

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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