Antibiotic Use in First Year of Life Linked to Small Risk of Developing Asthma CME/CE

[Guest guest]

another CEU class for doctors

I would suggest that as you vaccinate more

conditions come up that doctors then use

antibiotics for (due to vaccine injury - ear infections, pneumonia, and more)

It is my experience that unvaccinated children

rarely, if ever, need antibiotics; rarely have

ear infections which so often follow vaccinations.

Also antibiotics are suppressive from a

homeopathic perspective and don't allow the

symptoms to cure. When the symptoms are

suppressed, the body has to find another outlet,

and in some cases that is asthma. Also would

suggest that some of these children are also

treated with steroids for skin conditions which

also suppress, resulting in increase in

asthma. If I were to design a study, would take

into account a lot more factors.

But good that it is recognized here that antibiotic use is linked to asthma

Sheri

http://cme.medscape.com/viewarticle/589252?src=cmenews

Antibiotic Use in First Year of Life Linked to

Small Risk of Developing Asthma CME/CE

News Author: Laurie Barclay, MD

CME Author: Penny Murata, MD

<http://cme.medscape.com/viewarticle/589252_author>Disclosures

Release Date: March 9, 2009; Valid for credit through March 9, 2010

Credits Available

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Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ for physicians;

Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians;

Nurses - 0.25 ANCC contact hours (0.25 contact

hours are in the area of pharmacology );

Pharmacists - 0.25 knowledge-based ACPE

continuing education credits for pharmacists (0.025 CEUs)

[]

To participate in this internet activity: (1)

review the target audience, learning objectives,

and author disclosures; (2) study the education

content; (3) take the post-test and/or complete

the evaluation; (4) view/print certificate

<http://cme.medscape.com/viewarticle/589252_cmeinfo>View details.

Learning Objectives

Upon completion of this activity, participants will be able to:

* Describe whether antibiotic exposure in the

first year of life is linked with the development of asthma in children.

* Report whether a dose-response relationship

exists between antibiotic exposure in the first

year of life and the development of asthma in children.

Authors and Disclosures

Laurie Barclay, MD

Disclosure: Laurie Barclay, MD, has disclosed no

relevant financial relationships.

Penny Murata, MD

Disclosure: Penny Murata, MD, has disclosed no

relevant financial relationships.

Laurie Scudder, MS, NP

Disclosure: Laurie Scudder, MS, NP, has disclosed

no relevant financial information.

Brande

Disclosure: Brande has disclosed no

relevant financial information.

March 9, 2009 ­ Antibiotic use in the first year

of life is linked to a small risk for the

development of asthma, and this risk increases

with the number of courses of antibiotics

prescribed, according to the results of a study

reported in the March issue of Pediatrics.

" Antibiotic exposure in early childhood is a

possible contributor to the increasing asthma

prevalence in industrialized countries, " write

Fawziah Marra, PharmD, from University of British

Columbia in Vancouver, and colleagues. " Although

a number of published studies have tested this

hypothesis, the results have been conflicting. "

The goal of this study was to evaluate the

association between antibiotic exposure before

age 1 year and development of childhood asthma,

using administrative data from 1997 to 2003 birth

cohorts. The investigators assessed antibiotic

exposure during the first year of life in 251,817

infants, as well as the incidence of asthma after

the first 24 months of life in both those exposed

and not exposed to antibiotics in the first 12 months of life.

proportional hazards models allowed

adjustment for potential confounders (sex;

socioeconomic status; urban or rural address;

birth weight; gestational age; delivery method;

frequency of clinician visits; hospital visit

involving surgery; visits to an allergist,

respirologist, or immunologist; congenital

anomalies; and the presence of otitis media,

acute bronchitis, or chronic bronchitis; and

upper and lower respiratory tract infections)

during the first year of life. Hazard ratios were

calculated for the development of asthma associated with antibiotic exposure.

After adjustment, antibiotic exposure in the

first year of life was associated with a small

risk for the development of asthma in early

childhood. The number of courses of antibiotics

was associated with increased asthma risk, and

this risk was highest in children treated with

more than 4 courses of antibiotics. Except for

sulfonamides, all antibiotics were associated

with an increased risk for the development of asthma.

" This study provides evidence that the use of

antibiotics in the first year of life is

associated with a small risk of developing

asthma, and this risk increases with the number

of courses of antibiotics prescribed, " the study authors write.

Limitations of this study include data not

collected for the purposes of research, resulting

in some problems with the data and coding

inconsistencies; inability to adjust for all

relevant variables; and inability to conclusively determine causality.

" We have shown that in a large, population-based

cohort, after careful conducted analyses

adjusting for many potential confounders and with

multiple sensitivity analyses, the association

between antibiotic exposure and the subsequent

development of asthma remains, " the study authors conclude.

The BC Lung Association (British Columbia,

Canada) supported this study. The study authors

have disclosed no relevant financial relationships.

Pediatrics. 2009;123:1003-1010.

Clinical Context

According to the Centers for Disease Control and

Prevention, reported in the October 13, 2000,

issue of MMWR Morbidity and Mortality Weekly

Report, the prevalence of childhood asthma

increased 2-fold between a 1980 survey and a 1999

survey. The use of antibiotics in children also

increased in the late 1980s and early 1990s, as

reported by Sharland in the August 2007 issue of

the Journal of Antimicrobial Chemotherapy. It is

not clear whether the increase in asthma

prevalence is linked with the increase in antibiotic use.

This longitudinal cohort study evaluates whether

antibiotic use in the first year of life is

associated with the development of childhood

asthma and whether the number of courses of

antibiotics is associated with the development of asthma.

Study Highlights

* 251,817 live births in British Columbia

during a 7-year period with at least 2 years of

follow-up data comprised the cohort group.

* Infants diagnosed with asthma in the first

2 years of life were excluded if asthma symptoms preceded antibiotic use.

* Data on demographics, birth, dispensed

asthma drugs and antibiotics, and clinician

visits were obtained by linking information from

the medical services plan and vital statistics bureau.

* Asthma medications included short-acting

beta-agonists, inhaled corticosteroids,

ipratropium, ketotifen, or leukotriene receptor antagonists.

* Antibiotic categories were penicillins,

cephalosporins, macrolides, sulfonamide, or other.

* Date of asthma diagnosis was time of first

hospital discharge for asthma, 2 medical claims

in a 12-month period, or 2 prescriptions for

asthma medication in a 12-month period.

* Incident asthma cases were identified from

age 2 years until the end of the study period,

death, or departure from the area.

* Mean follow-up period was 5.5 years (range, 2 - 9 years).

* 50% of infants were boys.

* 85% were from urban areas.

* Socioeconomic status was evenly distributed.

* 93% had birth weight between 2.5 kg and 4.5 kg.

* 65% had spontaneous vertex delivery.

* 108,958 (43%) had antibiotics prescribed in the first year of life.

* 18,864 (7%) had development of asthma during the follow-up period.

* Overall asthma incidence was 2.3 per 100 person-years of follow-up.

* Asthma incidence was higher at ages 2 to 3

years vs ages 5 to 9 years (2.72 vs 1.74 per 100 person-years).

* Increased asthma risk was associated with

male sex, urban residence, lower socioeconomic

status, lower birth weight, lower gestational

age, first cesarean delivery, forceps or vacuum

extraction, lack of congenital anomalies,

specialist visit, frequent clinicians visits in

the first year, more bronchitis and upper or

lower respiratory tract infections, and fewer otitis media infections.

* proportional hazards regression

analysis adjusted for potential confounders of

sex; residence; socioeconomic status; birth

weight; gestational age; delivery method;

frequency of clinician visits; visit to an

allergist, respirologist, or immunologist;

hospitalization for surgery; congenital

anomalies; and otitis media, bronchitis, upper or

lower respiratory tract infections.

* Antibiotic exposure in the first year of

life had a small, but positive, association with

asthma in childhood (adjusted hazard ratio

---

,

1.12; 95% confidence interval [CI], 1.08 - 1.16; P < .0001).

* Risk for asthma development increased as

the number of antibiotic courses in the first

year of life increased from 1 to 2 (adjusted HR,

1.11; 95% CI, 1.07 - 1.15; P < .0001), 3 to 4

(adjusted HR, 1.15; 95% CI, 1.09 - 1.22; P <

..0001), to more than 4 (adjusted HR, 1.30; 95% CI, 1.20 - 1.41; P < .0001).

* All antibiotic categories, except

sulfonamide and other, were linked with asthma risk.

* Macrolide antibiotics had the strongest

link with asthma (adjusted HR, 1.11; 95% CI, 1.06 - 1.17; P < .0001).

* Limitations of the study included lack of

adjustment for other confounders, including

maternal asthma, parental smoking, and exposure to mites.

Pearls for Practice

* Antibiotic use in the first year of life is

associated with a small, but statistically

significant, increased risk for asthma in childhood.

* The risk for the development of asthma in

childhood increases as the number of antibiotic

courses in the first year of life increases.

CME/CE Test

Questions answered incorrectly will be highlighted.

Which of the following most accurately describes

the association between antibiotic use in the

first year of life and the risk for asthma development in children?

Increased risk for asthma in childhood

Decreased risk for asthma in childhood

Neither increased nor decreased risk for asthma in childhood

Increased risk for asthma in adulthood

Decreased risk for asthma in adulthood

A 10-month-old infant has received 2 courses of

antibiotics. Which of the following number of

antibiotic courses in an infant is most likely to

be associated with the highest risk for the development of asthma as a child?

1

2

3

4

5

Medscape Medical News 2009. ©2009 Medscape

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therapies described in this educational activity.

--------------------------------------------------------

Sheri Nakken, R.N., MA, Hahnemannian Homeopath

Vaccination Information & Choice Network, Nevada City CA & Wales UK

Vaccines - http://www.wellwithin1.com/vaccine.htm

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