title: Infant antibiotic use and wheeze and asthma risk: a systematic review and meta-analysis.
abstract: Our aim was to systematically review and meta-analyse longitudinal studies on antibiotic use and subsequent development of wheeze and/or asthma with regards to study quality, outcome measurement, reverse causation (RC; wheezing/asthma symptoms have caused prescription of antibiotics) and confounding by indication (CbI; respiratory tract infections leading to antibiotic use may be the underlying cause triggering asthma symptom development). English-language papers and studies published before November 1, 2010 with longitudinal observational design were included. Study quality was assessed using the Newcastle-Ottawa scale. We identified 21 longitudinal studies. The effect of antibiotic use on wheeze/asthma risk varied between studies. 18 studies were eligible for meta-analysis showing pooled OR 1.27 (95% CI 1.12-1.43) for wheeze/asthma. When we eliminated studies with possible RC and CbI, the pooled risk estimate in the nine remaining studies was attenuated to OR 1.12 (95% CI 0.98-1.26). Definition of wheeze/asthma and age at follow-up differed between studies. Three studies focused on wheeze/asthma beyond 5-6 yrs of age with the presence of active symptoms and/or medication (pooled OR 1.08, 95% CI 0.93-1.23; dominated by one study). RC and CbI lead to overestimation of the association between antibiotic use and subsequent development of wheeze/asthma. Association was weak when fully adjusted for these types of bias. Heterogeneity of disease definition between studies could affect the results.
authors.affiliation: Department of Medical Microbiology, Maastricht University Medical Centre, P.O Box 5800, NL-6202 AZ, Maastricht, The Netherlands. j.penders@maastrichtuniversity.nl
authors.forename: J
authors.initials: J
authors.lastname: Penders
authors.forename: I
authors.initials: I
authors.lastname: Kummeling
authors.forename: C
authors.initials: C
authors.lastname: Thijs
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D001249:Asthma / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D012135:Respiratory Sounds / Q000187:drug effects*; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D012306:Risk
chemical_list: D000900:Anti-Bacterial Agents