Zhao Huawei, Luo Yijun, Li Wenmi, Jiang Chenke, Jin Endai, Xu Zhenghao
Department of Pharmacy, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310052, China.
Research Center for Clinical Pharmacy, Zhejiang University, Hangzhou, 310058, China.
EClinicalMedicine. 2025 Jun 10;84:103296. doi: 10.1016/j.eclinm.2025.103296. eCollection 2025 Jun.
Antibiotics constitute a prevalent class of medications prescribed for pediatric patients. Concerns have arisen regarding the impact of early-life antibiotic use on the risk of atopic illnesses, including childhood atopic dermatitis (AD). AD affects approximately 2% of adults but is twice as prevalent in children, with rates ranging up to 4%. Therefore, the potential correlation between antibiotic exposure and childhood AD is of significant concern.
Relevant literature was searched from English databases (PubMed, Web of science, Scopus, and The Cochrane Library) and Chinese databases (CNKI database, VIP Database, Wanfang Database) to May 1, 2025. Random-effects meta-analyses were conducted to assess the association between antibiotic exposure and the risk of childhood AD. This study is registered with PROSPERO (CRD42024535141).
A total of 39 literature sources were included, encompassing 7,487,925 children. Meta-analysis showed that antibiotic exposure during pregnancy and childhood is associated with an increased risk of childhood AD (OR = 1.22, 95% CI: 1.17-1.28; heterogeneity: I = 98.06%). The subgroup analyses showed that: (1) Children exposed to antibiotics during childhood had a higher risk of developing AD compared to those exposed to antibiotics during pregnancy; (2) the increased risk of AD following antibiotic exposure was significantly affected by the diagnostic criteria and race, but not living areas; (3) antibiotic exposure frequency and type of antibiotics may contribute to the increased risk of AD following antibiotic exposure; (4) the increased risk of AD following antibiotic exposure seems to be positive related with age of outcome measure but not the age of exposure.
Antibiotic exposure during pregnancy or early childhood enhances AD risk, with childhood exposure posing a higher risk than prenatal exposure. Exposure time (during pregnancy and childhood) and the age at outcome measurement are important influencing factors for this association. Diagnostic criteria, race, frequency of antibiotic exposure, and type of antibiotics may also affect this relationship. While the observed statistical significance may be associated with the increased statistical power afforded by the large sample size, the clinical implications of these findings warrant cautious interpretation. Further comprehensive and high-quality studies are warranted to clarify these findings.
This work was supported by the Natural Science Foundation of Zhejiang (LYY22H310002), the Medical Science and Technology Project of Zhejiang Province (2024KY1170), Special Fund for the Incubation of Young Clinical Scientist, The Children's Hospital of Zhejiang University School of Medicine (CHZJU2023YS006).
抗生素是儿科患者常用的一类药物。早期使用抗生素对特应性疾病风险的影响，包括儿童特应性皮炎（AD），已引起关注。AD影响约2%的成年人，但在儿童中患病率是成年人的两倍，高达4%。因此，抗生素暴露与儿童AD之间的潜在关联备受关注。
检索英文数据库（PubMed、Web of science、Scopus和Cochrane图书馆）和中文数据库（CNKI数据库、维普数据库、万方数据库）至2025年5月1日的相关文献。进行随机效应荟萃分析，以评估抗生素暴露与儿童AD风险之间的关联。本研究已在PROSPERO（CRD42024535141）注册。
共纳入39篇文献，涉及7487925名儿童。荟萃分析表明，孕期和儿童期抗生素暴露与儿童AD风险增加相关（OR = 1.22，95%CI：1.17 - 1.28；异质性：I² = 98.06%）。亚组分析显示：（1）儿童期暴露于抗生素的儿童患AD的风险高于孕期暴露于抗生素的儿童；（2）抗生素暴露后AD风险增加受诊断标准和种族影响显著，但不受居住地区影响；（3）抗生素暴露频率和抗生素类型可能导致抗生素暴露后AD风险增加；（4）抗生素暴露后AD风险增加似乎与结局测量年龄呈正相关，但与暴露年龄无关。
孕期或儿童早期抗生素暴露会增加AD风险，儿童期暴露的风险高于产前暴露。暴露时间（孕期和儿童期）以及结局测量年龄是这种关联的重要影响因素。诊断标准、种族、抗生素暴露频率和抗生素类型也可能影响这种关系。虽然观察到的统计学显著性可能与大样本量提供的统计效力增加有关，但这些发现的临床意义仍需谨慎解读。需要进一步开展全面、高质量的研究来阐明这些发现。
本研究得到浙江省自然科学基金（LYY22H310002）、浙江省医药卫生科技项目（2024KY1170）、浙江大学医学院附属儿童医院青年临床科学家孵化专项基金（CHZJU2023YS006）的支持。
