Children who received at least one course of antibiotics during the first two years of life have an increased risk of developing allergic diseases (asthma, atopic dermatitis, allergic rhinitis), celiac disease, obesity, and attention deficit hyperactivity disorder. The use of multiple antimicrobials in early childhood increases the likelihood of a combination of these conditions.

Today, there is no doubt that the human microbiota plays a vital role in the development of the immune system, metabolism, and even behavior and cognitive processes. Disruptions in the composition and diversity of the microbiota (dysbiotic conditions) can cause various diseases, and dysbiosis is especially dangerous for young children. The state of the intestinal microbiota is influenced by many factors, ranging from the mode of birth (natural birth or cesarean section), the type of feeding (breastfeeding or formula), and diet to infections and geographical conditions. Antimicrobials are a significant factor influencing intestinal microorganisms.

Scientists from the renowned Mayo Clinic (USA) conducted* a retrospective analysis of the medical records of nearly all individuals living in Olmsted County (Minnesota, USA) over the past 50 years, accumulating information about their illnesses and medications. The study included all children born in Olmsted between January 1, 2003, and December 31, 2011. There were more than 14,500 such children (excluding children with congenital abnormalities and children from multiple pregnancies). Of these, 23% were born by cesarean section. About 70% of the children (10,200) received at least one course of antibiotic therapy before age 2, and most of them received multiple courses.

Most often, children were prescribed penicillins, cephalosporins, and macrolides; 99% of antibiotics were administered orally.

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Both boys and girls who received at least one course of antibiotics had a higher cumulative incidence of asthma, allergic rhinitis, overweight, and attention deficit hyperactivity disorder. Girls had a greater risk of developing atopic dermatitis and celiac disease, while boys had a greater risk of obesity. Among children who received one to two courses of antibiotics, girls had a significantly higher risk of developing asthma and celiac disease compared with children who did not receive antibiotics; three to four courses of antibiotics increased the risk of asthma, atopic dermatitis, and overweight in both boys and girls. More than five courses of antibiotics for both sexes were associated with a significantly higher risk of developing asthma, allergic rhinitis, overweight, obesity, and attention deficit hyperactivity disorder (and, for girls, celiac disease) than their peers who did not receive antibiotics.

A more significant increase in the risk of developing these diseases was observed with the use of cephalosporins; in particular, a link was established between their use and the development of autism and food allergies.

Antibiotic use in the first six months of life was associated with an increased risk of atopic dermatitis, excess weight, and attention deficit hyperactivity disorder in both sexes. Girls had an increased risk of asthma, allergic rhinitis, and obesity, while boys had an increased risk of food allergies.

In their calculations, the scientists adjusted for other factors that increase the risk of developing these pathologies, including male gender, birth by cesarean section, high birth weight, the use of antibiotics, and maternal smoking during pregnancy.

Antibiotics are extremely important medications that save many lives. However, their irrational use has serious consequences for both individuals and humanity as a whole. Minimizing the risks of antimicrobial therapy in children requires particular attention: a balanced approach to prescribing and, whenever possible, choosing safer alternative antimicrobials.

* Aversa Z, Atkinson EJ, Schafer MJ et al. Association of Infant Antibiotic Exposure With Childhood Health Outcomes. Mayo Clinic Proceedings, November 15, 2020. https://doi.org/10.1016/j.mayocp.2020.07.0192020