Antibiotic-induced mesenteric adenopathy in an intussusception mouse model: a randomized, controlled trial.
BACKGROUND
Idiopathic intussusception is a leading cause of intestinal obstruction in young children. Although the etiology remains obscure, lymphoid hyperplasia is found in a majority of cases. Antibiotics, the most frequently prescribed medication class in the pediatric population, have been recently associated with intussusception. The authors sought to determine whether enteral antibiotic exposure influences the development of mesenteric adenopathy, bowel dilation or intussusception in an animal model.


METHODS
The authors conducted a randomized, controlled animal trial using a previously described intussusception model. Mice were gavaged with normal saline, amoxicillin-clavulanate or azithromycin twice daily for 5 days to assess the influence of enteral antibiotic exposure on intussusception, mesenteric adenopathy and bowel dilation. One pediatric surgeon performed all laparotomies and was blinded to group designation. Chi2 and Fisher exact tests were used to evaluate differences between antibiotic exposed and control groups.


RESULTS
Mesenteric adenopathy was identified in 4.1% of the normal saline controls compared with 54.1% (P < 0.01) and 38.9% (P < 0.01) of the amoxicillin-clavulanate and azithromycin exposed animals, respectively. A total of four intussusceptions were observed in the antibiotic-exposed groups combined whereas no intussusception cases were identified in the control group (P = 0.30).


CONCLUSIONS
This is the first study to describe a significant association between antibiotic use and mesenteric adenopathy in any animal species.
Spiro
David M
DM
Department of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA. david.spiro@yale.edu
Schmidt
James M
JM
Arnold
Donald H
DH
Cartner
Samuel C
SC
Yagmurlu
Aydin
A
D019980:Amoxicillin-Potassium Clavulanate Combination / Q000009:adverse effects; D000818:Animals; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D017963:Azithromycin / Q000009:adverse effects; D004195:Disease Models, Animal; D005260:Female; D007421:Intestine, Small / Q000473:pathology; D007443:Intussusception / Q000139:chemically induced* / Q000473:pathology; D008206:Lymphatic Diseases / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D008643:Mesentery / Q000473:pathology; D051379:Mice; D008807:Mice, Inbred BALB C; D010532:Peritoneal Diseases / Q000139:chemically induced* / Q000473:pathology; D011897:Random Allocation
D000900:Anti-Bacterial Agents; D019980:Amoxicillin-Potassium Clavulanate Combination; D017963:Azithromycin