The effect of early life antibiotic exposures on diarrheal rates among young children in Vellore, India.
BACKGROUND
Antibiotic treatment of childhood illnesses is common in India. In addition to contributing to antimicrobial resistance, antibiotics might result in increased susceptibility to diarrhea through interactions with the gastrointestinal microbiota. Breast milk, which enriches the microbiota early in life, may increase the resilience of the microbiota against perturbations by antibiotics.


METHODS
In a prospective observational cohort study, we assessed whether antibiotic exposures from birth to 6 months affected rates of diarrhea up to age 3 years among 465 children from Vellore, India. Adjusting for treatment indicators, we modeled diarrheal rates among children exposed and unexposed to antibiotics using negative binomial regression. We further assessed whether the effect of antibiotics on diarrheal rates was modified by exclusive breastfeeding at 6 months.


RESULTS
More than half of the children (n = 267, 57.4%) were given at least one course of antibiotics in the first 6 months of life. The adjusted relative incidence rate of diarrhea was 33% higher among children who received antibiotics under 6 months of age compared with those who did not (incidence rate ratio: 1.33, 95% confidence interval: 1.12, 1.57). Children who were exclusively breastfed until 6 months of age did not have increased diarrheal rates following antibiotic use.


CONCLUSIONS
Antibiotic exposures early in life were associated with increased rates of diarrhea in early childhood. Exclusive breastfeeding might protect against this negative impact.
From the *Department of Epidemiology, †Department of Family Medicine, ‡Department of Nutrition, §Department of Medicine, UNC-Chapel Hill, North Carolina; ¶Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India; and ‖Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts.
Elizabeth T
ET
Rogawski
Daniel
D
Westreich
Sylvia
S
Becker-Dreps
Linda S
LS
Adair
Robert S
RS
Sandler
Rajiv
R
Sarkar
Deepthi
D
Kattula
Honorine D
HD
Ward
Steven R
SR
Meshnick
Gagandeep
G
Kang
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001942:Breast Feeding; D002675:Child, Preschool; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology*; D004363:Drug Utilization; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies
D000900:Anti-Bacterial Agents