资源匮乏地区早期接触抗生素与生命最初两年体重增加有关。
Early Antibiotic Exposure in Low-resource Settings Is Associated With Increased Weight in the First Two Years of Life.
作者信息
Rogawski Elizabeth T, Platts-Mills James A, Seidman Jessica C, John Sushil, Mahfuz Mustafa, Ulak Manjeswori, Shrestha Sanjaya, Soofi Sajid B, Yori Pablo Penataro, Mduma Estomih, Svensen Erling, Ahmed Tahmeed, Lima Aldo A M, Bhutta Zulfiqar, Kosek Margaret, Lang Dennis, Gottlieb Michael, Zaidi Anita, Kang Gagandeep, Bessong Pascal, Houpt Eric R, Guerrant Richard L
机构信息
*Department of Public Health Sciences †Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA ‡Fogarty International Center, National Institutes of Health, Bethesda, MD §Christian Medical College, Vellore, India ||International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh ¶Institute of Medicine, Tribhuvan University #Walter Reed/Armed Forces Research Institute of Medical Sciences Research Unit, Kathmandu, Nepal **Center for International Health, University of Bergen, Bergen, Norway ††Aga Khan University, Karachi, Pakistan ‡‡Asociación Benéfica PRISMA, Iquitos, Peru §§Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD ||||Haydom Lutheran Hospital, Haydom, Tanzania ¶¶Haukeland University Hospital, Bergen, Norway ##Clinical Research Unit and Institute of Biomedicine, Federal University of Ceara, Fortaleza, Brazil ***Foundation for the National Institutes of Health, Bethesda, MD †††University of Venda, Thohoyandou, South Africa.
出版信息
J Pediatr Gastroenterol Nutr. 2017 Sep;65(3):350-356. doi: 10.1097/MPG.0000000000001640.
OBJECTIVES
The potential growth-promoting effects of antibiotics are not well understood among undernourished children in environments with high pathogen exposure. We aimed to assess whether early antibiotic exposure duration and class were associated with growth to 2 years of age across 8 low-resource sites in the MAL-ED birth cohort study.
METHODS
We followed 1954 children twice per week from birth to 2 years to record maternally reported antibiotic exposures and measure anthropometry monthly. We estimated the associations between antibiotic exposure before 6 months of age and weight-for-age and length-for-age (LAZ) z scores to 2 years. We assessed the impact of class-specific exposures and duration, and compared these results to effects of antibiotic exposures after 6 months of age.
RESULTS
Antibiotic use before 6 months of age was associated with increased weight from 6 months to 2 years, whereas associations with length were less consistent across sites and antibiotic classes. Compared to unexposed children, 2 or more courses of metronidazole, macrolides, and cephalosporins were associated with adjusted increases in weight-for-age of 0.24 (95% confidence interval (CI): 0.04, 0.43), 0.23 (95% CI: 0.05, 0.42), and 0.19 (95% CI: 0.04, 0.35) from 6 months to 2 years, respectively.
CONCLUSIONS
Antibiotic use in low-resource settings was most associated with the ponderal growth of children who had multiple exposures to antibiotics with broad spectrum and anaerobic activity in early infancy. Opportunities for rational and targeted antibiotic therapy in low resource settings may also promote short-term weight gain in children, although longer-term physical growth and metabolic impacts are unknown.
目的
在病原体暴露风险高的环境中，营养不良儿童对抗生素潜在的生长促进作用了解不足。我们旨在评估在MAL-ED出生队列研究的8个资源匮乏地区，早期抗生素暴露时长和种类与2岁时的生长发育之间是否存在关联。
方法
我们对1954名儿童从出生到2岁每周随访两次，记录母亲报告的抗生素暴露情况，并每月测量人体测量数据。我们估计了6个月龄前抗生素暴露与2岁时年龄别体重和年龄别身长（LAZ）z评分之间的关联。我们评估了特定种类暴露和暴露时长的影响，并将这些结果与6个月龄后抗生素暴露的影响进行比较。
结果
6个月龄前使用抗生素与6个月至2岁体重增加有关，而与身长的关联在不同地区和抗生素种类中不太一致。与未暴露儿童相比，2个或更多疗程的甲硝唑、大环内酯类和头孢菌素与6个月至2岁时年龄别体重调整后增加分别为0.24（95%置信区间（CI）：0.04，0.43）、0.23（95%CI：0.05，0.42）和0.19（95%CI：0.04，0.35）。
结论
在资源匮乏地区，抗生素使用与婴儿期多次暴露于具有广谱和厌氧活性抗生素的儿童的体重增长最为相关。在资源匮乏地区进行合理和有针对性的抗生素治疗，可能也会促进儿童短期体重增加，尽管其对长期身体生长和代谢的影响尚不清楚。
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