Dose, Timing, and Type of Infant Antibiotic Use and the Risk of Childhood Asthma
Dose, Timing, and Type of Infant Antibiotic Use and the Risk of Childhood Asthma
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DOI：
10.1093/cid/ciz448
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发表时间：
2020-04-15
影响因子：
11.8
通讯作者：
Wu, Pingsheng
中科院分区：
文献类型：
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作者：
Donovan, Brittney M.;Abreo, Andrew;Wu, Pingsheng
背景：对婴儿抗生素暴露及其与哮喘发生的关系进行了不同程度的探讨。我们的目的是全面和同步地评估婴儿使用抗生素的剂量、时间和类型对儿童哮喘风险的影响。方法：纳入田纳西州医疗补助计划登记的单胎、足月出生、非低出生体重和其他健康儿童。婴儿抗生素的使用和儿童哮喘的诊断是从处方填写和医疗保健遭遇索赔中确定的。结果：在152 622名儿童中，79%的儿童在婴儿期至少服用过一次抗生素处方。婴儿使用抗生素与儿童哮喘发病几率的增加呈剂量依赖关系，每填写一张抗生素处方，婴儿患哮喘的几率增加20%(调整后的优势比[AOR]，1.20[95%可信区间{CI}，1.19-1.20])。在对抗生素的时间和类型进行额外控制后，这种显著的剂量依赖关系仍然存在。与仅使用窄谱抗生素填充的婴儿相比，仅使用广谱抗生素填充的婴儿患哮喘的几率更高(AOR，1.10[95%CI，1.05-1.19])。时间、配方、厌氧覆盖率和抗生素种类与儿童哮喘之间没有显著的相关性。结论：我们发现婴儿期的抗生素处方用量与儿童哮喘的后续发展之间存在一致的剂量依赖关系。我们的研究为婴儿抗生素暴露的特定方面提供了重要的见解。在婴儿期使用抗生素之前，应严格评估有关抗生素管理和预防不良反应的临床决策。
Background: Aspects of infant antibiotic exposure and its association with asthma development have been variably explored. We aimed to evaluate comprehensively and simultaneously the impact of dose, timing, and type of infant antibiotic use on the risk of childhood asthma.Methods: Singleton, term-birth, non-low-birth-weight, and otherwise healthy children enrolled in the Tennessee Medicaid Program were included. Infant antibiotic use and childhood asthma diagnosis were ascertained from prescription fills and healthcare encounter claims. We examined the association using multivariable logistic regression models.Results: Among 152 622 children, 79% had at least 1 antibiotic prescription fill during infancy. Infant antibiotic use was associated with increased odds of childhood asthma in a dose-dependent manner, with a 20% increase in odds (adjusted odds ratio [aOR], 1.20 [95% confidence interval {CI}, 1.19-1.20]) for each additional antibiotic prescription filled. This significant dose-dependent relationship persisted after additionally controlling for timing and type of the antibiotics. Infants who had broad-spectrum-only antibiotic fills had increased odds of developing asthma compared with infants who had narrow-spectrum-only fills (aOR, 1.10 [95% CI, 1.05-1.19]). There was no significant association between timing, formulation, anaerobic coverage, and class of antibiotics and childhood asthma.Conclusions: We found a consistent dose-dependent association between antibiotic prescription fills during infancy and subsequent development of childhood asthma. Our study adds important insights into specific aspects of infant antibiotic exposure. Clinical decision making regarding antibiotic stewardship and prevention of adverse effects should be critically assessed prior to use during infancy.