Antibiotic use may increase risk of inflammatory bowel disease – New Telegraph

Antibiotic use may increase the risk of inflammatory bowel illness (Crohn’s disease and ulcerative colitis) in people over 40. These are the results of a study published online in the journal ‘Gut’. The risk seems to be cumulative and greatest among persons between one to two years after use and for those antibiotics targeting gut infections, the findings indicate. Mounting evidence suggests that environmental factors are likely implicated in the development of inflammatory bowel disease (IBD). Globally, close to seven million people have the condition, with this number expected to rise over the next decade, said the researchers.

One factor associated with IBD risk in younger people is the use of antibiotics, but it’s not clear if this association might also apply to older people. To explore this further, the researchers drew on national medical data from 2000 to 2018 for Danish citizens aged 10 upwards who hadn’t been diagnosed with IBD. They specifically wanted to know if the timing and dose of antibiotic might be important for the development of IBD, and whether this varied by IBD and antibiotic type. More than 6.1 million people were included in the study, just over half of whom were female.

In total, 5.5 million (91 per cent) were prescribed at least one course of antibiotics between 2000 and 2018. During this period, some 36,017 new cases of ulcerative colitis and 16,881 new cases of Crohn’s disease were diagnosed. Overall, compared with no antibiotic use, use of these drugs was associated with a higher risk of developing IBD, regardless of age. But older age was associated with the highest risk. Those aged 10-40 were 28 per cent more likely to be diagnosed with IBD; 40-60 year olds were 48 per cent more likely to do so, while the over 60s were 47 per cent more likely to do so. The risks were slightly higher for Crohn’s disease than they were for ulcerative colitis: 40 per cent among 10 to 40 year olds; 62 per cent among 40 to 60 year olds; and 51 per cent among the over 60s.

The risk seemed to be cumulative,with each subsequent course adding an additional 11 per cent, 15 per cent, and 14 per cent heightened risk, according to age band. The highest risk of all was observed among those prescribed five or more courses of antibiotics: 69 per cent heightened risk for 10 to 40 year olds; a doubling in risk for 40 to 60 year olds; and a 95 per cent heightened risk for the over 60s. Timing also seemed to be influential, with the highest risk for IBD occurring one to two years after antibiotic exposure, with each subsequent year thereafter associated with a lowering in risk. Specifically, among 10 to 40 year olds IBD risk was 40 per cent higher one to two years after taking antibiotics compared with 13 per cent four to five years later.

The equivalent figures for 40 to 60 year olds were 66 per cent vs 21 per cent and for the over 60s 63 per cent vs 22 per cent. As to antibiotic type, the highest risk of IBD was associated with the nitroimidazoles and fluoroquinolones, which are usually used to treat gut infections.

These are known as broad spectrum antibiotics because they indiscriminately target all microbes, not just those that cause disease. Nitrofurantoin was the only antibiotic type not associated with IBD risk at any age. Narrow spectrum penicillins were also associated with IBD, although to a much lesser extent. This adds weight to the notion that changes in the gut microbiome may have a key role and that many antibiotics have the potential to alter the makeup of microbes in the gut. This is an observational study, and as such, can’t establish cause. But there are some plausible biological explanations for the findings, they suggest, highlighting the natural diminution of both the resilience and range of microbes in the gut microbiome associated with ageing, which antibiotic use is likely to compound.

“Furthermore, with repeated courses of antibiotics, these shifts can become more pronounced, ultimately limiting recovery of the intestinal microbiota,” they added. Limiting prescriptions for antibiotics may not only help to curb antibiotic resistance but may also help lower the risk of IBD, they venture.

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