A cohort study confirms early antibiotic exposure as a risk factor for the development of pediatric IBD, underscoring the importance of antibiotic stewardship.

“We still do not know exactly why some people develop pediatric-onset IBD. Early life environmental factors seem to play a larger role in pediatric onset as compared with later-onset IBD,” explained Mikkel Malham, MD, of Copenhagen University Hospital.

With his team, Dr. Malham aimed to assess the risk for developing pediatric-onset IBD after exposure to antibiotics during the first 5 years of life. Included were all patients with IBD from 1980 in the nationwide health registry in Denmark who were diagnosed before age 18 and followed through 2018. These patients were matched with up to 10 healthy individuals of the same age, sex, and area of residence. Patients diagnosed before 6 years of age were excluded to avoid other etiologies, like monogenic causes of IBD.

In all, 1,808 patients with pediatric-onset IBD, including 989 with Crohn’s disease and 819 with ulcerative colitis, and 17,234 matched controls were in the analysis. Among patients with IBD, 1,578 had at least one prescription for antibiotics between birth and 5 years compared with 14,525 prescriptions in the reference group.

Over time, the overall risk for developing IBD increased in patients prescribed antibiotics during the first 5 years (HR, 1.26). “We noticed that mainly Crohn´s disease is associated with increased antibiotics prescriptions,” Dr. Malham said.

In addition, the risk for IBD was more pronounced in patients that had four or more antibiotic prescriptions compared with no antibiotic prescription (HR, 1.43; P<0.0001). The risk for IBD also depended on the specific antibiotic prescribed; it was higher for broad-spectrum antibiotics compared with narrow-spectrum antibiotics.

Thus, this study confirms the critical influence of antibiotic prescriptions in the development of pediatric-onset IBD.

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