Marra Fawziah, Marra Carlo A, Richardson Kathryn, Lynd Larry D, Kozyrskyj Anita, Patrick David M, Bowie William R, Fitzgerald J Mark
University of British Columbia, Faculty of Pharmaceutical Sciences, Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, 620-1081 Burrard St, Vancouver, British Columbia, Canada.
Pediatrics. 2009 Mar;123(3):1003-10. doi: 10.1542/peds.2008-1146.
Antibiotic exposure in early childhood is a possible contributor to the increasing asthma prevalence in industrialized countries. Although a number of published studies have tested this hypothesis, the results have been conflicting.
To explore the association between antibiotic exposure before 1 year of age and development of childhood asthma.
Using administrative data, birth cohorts from 1997 to 2003 were evaluated (N = 251817). Antibiotic exposure was determined for the first year of life. After the first 24 months of life, the incidence of asthma was determined in both those exposed and not exposed to antibiotics in the first 12 months of life. Cox proportional hazards models were used to adjust for potential confounders and determine the hazard ratios associated with antibiotic exposure for the development of asthma.
Antibiotic exposure in the first year of life was associated with a small risk of developing asthma in early childhood after adjusting for gender, socioeconomic status at birth, urban or rural address at birth, birth weight, gestational age, delivery method, frequency of physician visits, hospital visit involving surgery, visits to an allergist, respirologist, or immunologist, congenital anomalies, and presence of otitis media, acute, or chronic bronchitis, and upper and lower respiratory tract infections during the first year of life. As the number of courses of antibiotics increased, this was associated with increased asthma risk, with the highest risk being in children who received >4 courses. All antibiotics were associated with an increased risk of developing asthma, with the exception of sulfonamides.
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.
儿童早期接触抗生素可能是工业化国家哮喘患病率上升的一个原因。尽管已有多项发表的研究检验了这一假设，但结果相互矛盾。
探讨1岁前接触抗生素与儿童哮喘发病之间的关联。
利用行政数据对1997年至2003年的出生队列进行评估（N = 251817）。确定生命第一年的抗生素接触情况。在生命的前24个月后，确定在生命的前12个月接触和未接触抗生素的儿童的哮喘发病率。使用Cox比例风险模型调整潜在混杂因素，并确定与抗生素接触相关的哮喘发病风险比。
在调整了性别、出生时的社会经济地位、出生时的城乡地址、出生体重、孕周、分娩方式、就诊频率、涉及手术的医院就诊、看过敏科医生、呼吸科医生或免疫科医生的次数、先天性异常以及生命第一年是否存在中耳炎、急性或慢性支气管炎以及上、下呼吸道感染后，生命第一年接触抗生素与儿童早期患哮喘的风险较小相关。随着抗生素疗程数的增加，这与哮喘风险增加相关，风险最高的是接受>4个疗程的儿童。除磺胺类药物外，所有抗生素都与患哮喘的风险增加相关。
本研究提供的证据表明，生命第一年使用抗生素与患哮喘的风险较小相关，且这种风险随着所开抗生素疗程数的增加而增加。
