Australian Institute for Health Innovation, University of New South Wales, Sydney, Australia; Children's Hospital Informatics Program at Harvard-MIT Health Sciences and Technology, Boston Children's Hospital, Boston, Massachusetts.
Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Ann Allergy Asthma Immunol. 2014 May;112(5):441-445.e1. doi: 10.1016/j.anai.2014.01.022. Epub 2014 Mar 13.
The prevalence of asthma has increased alarmingly in the past 2 to 3 decades. Increased antibiotic use in infancy has been suggested to limit exposure to gastrointestinal microbes and to predispose to asthma in later life.
To evaluate the association between antibiotic exposure during the first year of life and the development of asthma up to the age of 7 years.
A retrospective population-based study of a cohort of children enrolled in a nationwide employer-provided health insurance plan from January 1, 1999, through December 31, 2006, in the United States (n = 62,576). We evaluated the association between antibiotic exposure during the first year of life and subsequent development of 3 asthma phenotypes: transient wheezing (began and resolved before 3 years of age), late-onset asthma (began after 3 years of age), and persistent asthma (began before 3 years of age and persisted through 4-7 years of age).
Antibiotic use in the first year of life was associated with the development of transient wheezing (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.9-2.2; P < .001) and persistent asthma (OR, 1.6; 95% CI, 1.5-1.7; P < .001). A dose-response effect was observed. When 5 or more antibiotic courses were received, the odds of persistent asthma doubled (OR, 1.9; 95% CI, 1.5-2.6; P < .001). There is no association between antibiotic use and late-onset asthma.
Antibiotic use in the first year life is associated with an increased risk of early-onset childhood asthma that began before 3 years of age. The apparent effect has a clear dose response. Heightened caution about avoiding unnecessary use of antibiotics in infants is warranted.
在过去的 2 到 3 十年中，哮喘的发病率惊人地增加。有人认为，婴儿时期抗生素的使用增加限制了胃肠道微生物的暴露，并使日后更容易患上哮喘。
评估婴儿期第一年接触抗生素与 7 岁前发生哮喘之间的关系。
这是一项在美国进行的回顾性基于人群的队列研究，纳入了 1999 年 1 月 1 日至 2006 年 12 月 31 日期间参加全国性雇主提供健康保险计划的儿童队列（n = 62576）。我们评估了婴儿期第一年接触抗生素与随后发生的 3 种哮喘表型之间的关系：一过性喘息（在 3 岁前出现并缓解）、迟发性哮喘（在 3 岁后出现）和持续性哮喘（在 3 岁前出现并持续至 4-7 岁）。
婴儿期使用抗生素与一过性喘息（比值比[OR]，2.0；95%置信区间[CI]，1.9-2.2；P <.001）和持续性哮喘（OR，1.6；95% CI，1.5-1.7；P <.001）的发生有关。观察到剂量-反应关系。当接受 5 次或更多次抗生素疗程时，持续性哮喘的几率增加一倍（OR，1.9；95% CI，1.5-2.6；P <.001）。抗生素使用与迟发性哮喘无关。
婴儿期第一年使用抗生素与 3 岁前发生的儿童早期哮喘发病风险增加有关。这种明显的效果有明确的剂量反应。有必要对避免婴儿不必要使用抗生素保持高度警惕。
