Risk of fibromyalgia following antibiotic prescriptions: A population-based case–control study

David Armstrong*, Alex Dregan, Mark Ashworth, Patrick White

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: The health of the gut microbiome is now recognized to be an important component of the gut–brain axis which itself appears to be implicated in pain perception. Antibiotics are known to create dysbiosis in the microbiome, so whether fibromyalgia is more commonly diagnosed after antibiotic prescriptions provides a means of exploring the role of the microbiome in the experience of chronic pain. Methods: A case–control study was carried out using electronic health records collected in the UK's Clinical Practice Research Datalink (CPRD), a comprehensive database of primary care consultations. For each case of diagnosed fibromyalgia, three controls were identified and matched by age, gender and GP practice. The exposure variable was the number and timing of antibiotic prescriptions over previous years. The analysis involved adjusting for a wide range of co-variates that might be possible confounders. Results: A total of 44,674 cases of fibromyalgia were identified together with 133,513 controls. After adjusting for co-variates, it was found that both the total number of prescriptions and their timing was associated with an FM diagnosis. For example, the quartile with the highest number of prescriptions and that with the longest exposure had a greater than three-fold increase in FM diagnoses (number of prescriptions: odds ratio 3.92; 95% CIs: 3.71–4.13; exposure odds ratio 3.28; CIs: 3.13–3.43). Some antibiotics (such as tetracyclines and metronidazole) seemed to confer greater risk than others. Conclusions: The results lend support for prior antibiotics being an important risk factor for a diagnosis of FM. Significance: This study shows an association between the volume as well as timing of prior antibiotic prescriptions and of a subsequent diagnosis of fibromyalgia in primary care.

Original languageEnglish
JournalEuropean Journal of Pain (United Kingdom)
Publication statusAccepted/In press - 2024


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