Does early life exposure to antibiotics increase the risk of eczema? A systematic review

TY - JOUR

T1 - Does early life exposure to antibiotics increase the risk of eczema? A systematic review

AU - Tsakok, T.

AU - McKeever, T. M.

AU - Yeo, L.

AU - Flohr, C.

PY - 2013/11

Y1 - 2013/11

N2 - A number of studies have suggested that early life exposure to antibiotics can lead to an increased risk of developing eczema. This systematic review and meta-analysis of observational studies, involving children or young adults aged 0-25 years, assessed the impact of antibiotic exposure either in utero or during the first 12 months of life on subsequent eczema risk. Twenty studies examined the association between prenatal and/or postnatal exposure to antibiotics and development of eczema. The pooled odds ratio (OR) for the 17 studies examining postnatal antibiotic exposure was 1·41 [95% confidence interval (CI) 1·30-1·53]. The pooled OR for the 10 longitudinal studies was 1·40 (95% CI 1·19-1·64), compared with a pooled OR of 1·43 (95% CI 1·36-1·51) for the seven cross-sectional studies. There was a significant dose-response association, suggesting a 7% increase in the risk of eczema for each additional antibiotic course received during the first year of life [pooled OR 1·07 (95% CI 1·02-1·11)]. Finally, the pooled OR for the four studies relating to antenatal exposure was 1·30 (95% CI 0·86-1·95). We conclude that exposure to antibiotics in the first year of life, but not prenatally, is more common in children with eczema. What's already known about this topic? A number of studies have suggested that early life exposure to antibiotics may lead to an increased risk of subsequent eczema. The evidence to date is conflicting and no systematic review has been conducted. What does this study add? Antibiotic exposure in early life may increase the risk of subsequent eczema by up to 40%, with broad-spectrum antibiotics having a more pronounced effect. Each additional antibiotic course may confer a further 7% risk increase. Antibiotics should be prescribed with caution, especially in high-risk children.

AB - A number of studies have suggested that early life exposure to antibiotics can lead to an increased risk of developing eczema. This systematic review and meta-analysis of observational studies, involving children or young adults aged 0-25 years, assessed the impact of antibiotic exposure either in utero or during the first 12 months of life on subsequent eczema risk. Twenty studies examined the association between prenatal and/or postnatal exposure to antibiotics and development of eczema. The pooled odds ratio (OR) for the 17 studies examining postnatal antibiotic exposure was 1·41 [95% confidence interval (CI) 1·30-1·53]. The pooled OR for the 10 longitudinal studies was 1·40 (95% CI 1·19-1·64), compared with a pooled OR of 1·43 (95% CI 1·36-1·51) for the seven cross-sectional studies. There was a significant dose-response association, suggesting a 7% increase in the risk of eczema for each additional antibiotic course received during the first year of life [pooled OR 1·07 (95% CI 1·02-1·11)]. Finally, the pooled OR for the four studies relating to antenatal exposure was 1·30 (95% CI 0·86-1·95). We conclude that exposure to antibiotics in the first year of life, but not prenatally, is more common in children with eczema. What's already known about this topic? A number of studies have suggested that early life exposure to antibiotics may lead to an increased risk of subsequent eczema. The evidence to date is conflicting and no systematic review has been conducted. What does this study add? Antibiotic exposure in early life may increase the risk of subsequent eczema by up to 40%, with broad-spectrum antibiotics having a more pronounced effect. Each additional antibiotic course may confer a further 7% risk increase. Antibiotics should be prescribed with caution, especially in high-risk children.

UR - http://www.scopus.com/inward/record.url?scp=84887053065&partnerID=8YFLogxK

U2 - 10.1111/bjd.12476

DO - 10.1111/bjd.12476

M3 - Review article

C2 - 23782060

AN - SCOPUS:84887053065

SN - 0007-0963

VL - 169

SP - 983

EP - 991

JO - British Journal of Dermatology

JF - British Journal of Dermatology

IS - 5

ER -