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  • Early childhood antibiotics and chronic pediatric conditions: a retrospective cohort study. The Journal of infectious diseases Beier, M. A., Setoguchi, S., Gerhard, T., Roy, J., Koffman, D., Mendhe, D., Madej, J., Strom, B. L., Blaser, M. J., Horton, D. B. 2025

    Abstract

    Early-childhood antibiotic exposure has been implicated in the development of chronic pediatric conditions, but many studies leave concerns about unmeasured confounding. We evaluated associations between early-childhood antibiotic exposure and allergic, autoimmune, or neurodevelopmental/psychiatric conditions.We performed a retrospective cohort study using electronic health records data from the United Kingdom (1987-2020). The primary exposure was antibiotic prescriptions between birth and age 2 years. Outcomes were diagnoses of chronic pediatric conditions (asthma/allergic, autoimmune, and neurodevelopmental/psychiatric) or forearm fracture (negative control). Adjusted hazard ratios with 95% confidence intervals were estimated using multivariable Cox regression models adjusted for maternal, child, and area-based socioeconomic status. A sibling-matched analysis was conducted using conditional Cox regression.Among 1,091,449 children, antibiotic exposure before age 2 was positively associated with asthma (hazard ratio 1.24, 1.22-1.26), food allergy (hazard ratio 1.33, 1.26-1.40), and allergic rhinitis (hazard ratio 1.06, 1.03-1.10), with stronger associations observed following multiple antibiotic courses. Findings from sibling-matched analyses were similar. Early-childhood antibiotic exposure was also dose-dependently associated with intellectual disability (5+ vs. 1-2 courses: hazard ratio 1.73, 1.49-2.01; sibling-matched: 2.79, 1.87-4.18), but not with celiac disease, inflammatory bowel disease, juvenile idiopathic arthritis, psoriasis, type 1 diabetes, attention-deficit/hyperactivity disorder, autism spectrum disorders, or anxiety. Sibling-matched results and a negative control outcome suggested minimal confounding bias.Children receiving multiple antibiotic courses between birth and age 2 were more likely to develop asthma, food allergies, allergic rhinitis, and intellectual disability. However, risks of most autoimmune, neurodevelopmental, and psychiatric conditions studied were minimal following early-childhood antibiotic exposure.

    View details for DOI 10.1093/infdis/jiaf191

    View details for PubMedID 40237450