TY - JOUR
T1 - Association between antibiotics and gut microbiome dysbiosis in children
T2 - systematic review and meta-analysis
AU - McDonnell, Lucy
AU - Gilkes, Alexander
AU - Ashworth, Mark
AU - Rowland, Victoria
AU - Harries, Timothy Hugh
AU - Armstrong, David
AU - White, Patrick
N1 - Funding Information:
LM is supported by a National Institute for Health Research (NIHR) In-Practice Fellowship. THH is supported by a National Institute for Health Research (NIHR) Doctoral Research Fellowship. This paper presents independent research. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. We are grateful to the library staff at King?s College London for their advice on the literature search strategy, and to Dr Iain Marshall for his advice on the quality assessment of included studies.
Publisher Copyright:
© 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - Antibiotics in childhood have been linked with diseases including asthma, juvenile arthritis, type 1 diabetes, Crohn’s disease and mental illness. The underlying mechanisms are thought related to dysbiosis of the gut microbiome. We conducted a systematic review of the association between antibiotics and disruption of the pediatric gut microbiome. Searches used MEDLINE, EMBASE and Web of Science. Eligible studies: association between antibiotics and gut microbiome dysbiosis; children 0–18 years; molecular techniques of assessment; outcomes of microbiome richness, diversity or composition. Quality assessed by Newcastle–Ottawa Scale or Cochrane Risk of Bias Tool. Meta-analysis where possible. A total of 4,668 publications identified: 12 in final analysis (5 randomized controlled trials (RCTs), 5 cohort studies, 2 cross-sectional studies). Microbiome richness was measured in 3 studies, species diversity in 6, and species composition in 10. Quality of evidence was good or fair. 5 studies found a significant reduction in diversity and 3 a significant reduction in richness. Macrolide exposure was associated with reduced richness for twice as long as penicillin. Significant reductions were seen in Bifidobacteria (5 studies) and Lactobacillus (2 studies), and significant increases in Proteobacteria such as E. coli (4 studies). A meta-analysis of RCTs of the effect of macrolide (azithromycin) exposure on the gut microbiome found a significant reduction in alpha-diversity (Shannon index: mean difference −0.86 (95% CI −1.59, −0.13). Antibiotic exposure was associated with reduced microbiome diversity and richness, and with changes in bacterial abundance. The potential for dysbiosis in the microbiome should be taken into account when prescribing antibiotics for children. Systematic review registration number: CRD42018094188.
AB - Antibiotics in childhood have been linked with diseases including asthma, juvenile arthritis, type 1 diabetes, Crohn’s disease and mental illness. The underlying mechanisms are thought related to dysbiosis of the gut microbiome. We conducted a systematic review of the association between antibiotics and disruption of the pediatric gut microbiome. Searches used MEDLINE, EMBASE and Web of Science. Eligible studies: association between antibiotics and gut microbiome dysbiosis; children 0–18 years; molecular techniques of assessment; outcomes of microbiome richness, diversity or composition. Quality assessed by Newcastle–Ottawa Scale or Cochrane Risk of Bias Tool. Meta-analysis where possible. A total of 4,668 publications identified: 12 in final analysis (5 randomized controlled trials (RCTs), 5 cohort studies, 2 cross-sectional studies). Microbiome richness was measured in 3 studies, species diversity in 6, and species composition in 10. Quality of evidence was good or fair. 5 studies found a significant reduction in diversity and 3 a significant reduction in richness. Macrolide exposure was associated with reduced richness for twice as long as penicillin. Significant reductions were seen in Bifidobacteria (5 studies) and Lactobacillus (2 studies), and significant increases in Proteobacteria such as E. coli (4 studies). A meta-analysis of RCTs of the effect of macrolide (azithromycin) exposure on the gut microbiome found a significant reduction in alpha-diversity (Shannon index: mean difference −0.86 (95% CI −1.59, −0.13). Antibiotic exposure was associated with reduced microbiome diversity and richness, and with changes in bacterial abundance. The potential for dysbiosis in the microbiome should be taken into account when prescribing antibiotics for children. Systematic review registration number: CRD42018094188.
KW - Antibiotics
KW - Children
KW - Gut dysbiosis
UR - http://www.scopus.com/inward/record.url?scp=85102176676&partnerID=8YFLogxK
U2 - 10.1080/19490976.2020.1870402
DO - 10.1080/19490976.2020.1870402
M3 - Article
AN - SCOPUS:85102176676
SN - 1949-0976
VL - 13
SP - 1
EP - 18
JO - Gut Microbes
JF - Gut Microbes
IS - 1
ER -
