Rogawski Elizabeth T, Westreich Daniel J, Becker-Dreps Sylvia, Adair Linda S, Sandler Robert S, Sarkar Rajiv, Kattula Deepthi, Ward Honorine D, Meshnick Steven R, Kang Gagandeep
Department of Epidemiology,
Department of Epidemiology.
Int J Epidemiol. 2015 Jun;44(3):978-87. doi: 10.1093/ije/dyv040. Epub 2015 Apr 29.
Antibiotics are commonly given for the treatment of childhood diarrhoea, but are not indicated in most cases. Antibiotics modify the gastrointestinal microbiota, which may have unanticipated effects on the risk of subsequent diarrhoea.
In a prospective observational cohort study, we assessed the effect of caregiver-reported antibiotic treatment for diarrhoea on the timing of a child's next episode among 434 children followed from birth to 3 years of age in Vellore, India. We estimated median time differences and time ratios from inverse probability of exposure-weighted Kaplan-Meier curves for the time to next diarrhoea episode, comparing children who did and did not receive antibiotics for the previous episode.
Study children had more than five diarrhoea episodes on average in the first 3 years of life, and more than a quarter of all episodes were treated with antibiotics. Children who received antibiotics for their first diarrhoea episode had their second episode on average 8 weeks earlier (median time difference: -8, 95% confidence interval: -10, -3) than children who did not receive antibiotics. The effects of antibiotics on subsequent diarrhoea were greatest at earlier episodes and younger ages, and cefixime had a slightly larger effect compared with cotrimoxazole.
Antibiotic treatment of diarrhoea was associated with reduced time to a subsequent diarrhoea episode, especially among younger infants. Whereas rational use of antibiotics has been advocated to reduce antimicrobial resistance in populations, we show that overuse of antibiotics may also have a direct adverse effect on individual patients.
抗生素常用于治疗儿童腹泻，但在大多数情况下并无必要。抗生素会改变胃肠道微生物群，这可能对后续腹泻风险产生意想不到的影响。
在一项前瞻性观察队列研究中，我们评估了印度韦洛尔434名从出生到3岁儿童的看护人报告的腹泻抗生素治疗对孩子下一次腹泻发作时间的影响。我们通过暴露加权的逆概率Kaplan-Meier曲线估计了下次腹泻发作时间的中位数差异和时间比，比较了前一次腹泻接受和未接受抗生素治疗的儿童。
研究儿童在生命的前3年平均有超过5次腹泻发作，超过四分之一的发作接受了抗生素治疗。首次腹泻发作接受抗生素治疗的儿童，其第二次发作的时间比未接受抗生素治疗的儿童平均早8周（中位数差异：-8，95%置信区间：-10，-3）。抗生素对后续腹泻的影响在早期发作和较小时期最为明显，与复方新诺明相比，头孢克肟的影响略大。
腹泻的抗生素治疗与后续腹泻发作时间缩短有关，尤其是在较小的婴儿中。虽然提倡合理使用抗生素以减少人群中的抗菌药物耐药性，但我们表明抗生素的过度使用也可能对个体患者产生直接的不利影响。
