title: Early exposure to antibiotics and infections and the incidence of atopic eczema: a population-based cohort study.
abstract: It has been suggested that infants exposed to antibiotics are at increased risk for atopic eczema (AE), whereas the early exposure to infections might be protective. This study describes the complex relationship between early exposure to infections, anti-infectious treatment with antibiotics, and incident AE. Using a German population-based administrative health-care and prescription database, we established a cohort of 370 children not diagnosed as having AE during their first year of life. For each individual child we identified all infections and prescriptions of antibiotics within the first year as well as incident AE within the second year of life. Crude analyses suggested that early infections and exposure to antibiotics are risk factors for AE. However, stratified analyses indicated that early infections were only associated with a higher rate of AE when treated with broad-spectrum antibiotics such as cephalosporines or macrolides. The risk ratio (RR) of children with early respiratory tract infections not treated with antibiotics was 0.69 [95% confidence interval (95% CI) 0.39 to 1.24], whereas respiratory tract infections treated with macrolides (RR: 2.15, 95% CI: 1.18-3.91) or cephalosporines (RR: 1.93, 95% CI: 1.07-3.49) significantly increased the risk for AE. The results for other common childhood infections tended to be similar. Antibiotic treatment appears to modify the association between early infections and subsequent AE. We found no evidence that infections per se significantly alter the likelihood for subsequent AE.
authors.affiliation: Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Germany. jochen.schmitt@uniklinikum-dresden.de
authors.forename: Jochen
authors.initials: J
authors.lastname: Schmitt
authors.forename: Natalie M
authors.initials: NM
authors.lastname: Schmitt
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Kirch
authors.forename: Michael
authors.initials: M
authors.lastname: Meurer
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002511:Cephalosporins / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003876:Dermatitis, Atopic / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D018942:Macrolides / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy*; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D018942:Macrolides