title: Patterns of Antibiotic Exposure and Clinical Disease Activity in Inflammatory Bowel Disease: A 4-year Prospective Study.
abstract: BACKGROUND
  Antimicrobial treatment is known to cause short- and long-term changes in the composition of normal human microbiota. The relationship between antibiotic use and overall clinical behavior in inflammatory bowel disease (IBD) has not been explored. We aim to prospectively characterize patterns of antibiotic use and clinical IBD activity in a large IBD cohort.
  
  
  METHODS
  Prospective observational study from a longitudinal IBD natural history registry between 2009 and 2012. Antibiotic prescriptions were identified and categorized using electronic medical record data. Cumulative rates over the 4-year study period were compared. Demographic, clinical, laboratory, health care utilization, and treatment data of the patients with IBD were collected and analyzed. Quality of life was measured by Short IBD Questionnaire data. Primary outcomes were markers of disease activity including Short IBD Questionnaire scores, C-reactive protein levels, health care utilization, and medication use.
  
  
  RESULTS
  Seven hundred eighteen patients followed over 4 years were included (47.6% male; mean age, 46.7 ± 15.2 yr), 59.9% had Crohn's disease, whereas 38.6% had ulcerative colitis. Most patients (66.3%) were exposed to antibiotics during the study period. Antibiotic-exposed patients were more likely to have Crohn's disease (63% versus 53.7%; P = 0.05), require narcotics (43.7% versus 14.9%; P < 0.0001), receive antidepressants (43.1% versus 18.6%; P < 0.001), prednisone (52.7% versus 31%; P < 0.0001), or biological therapy (52% versus 36.5%; P < 0.0001). Antibiotic-exposed patients had a lower mean Short IBD Questionnaire (50.2 ± 11.5 versus 56.4 ± 9.5; P < 0.0001), higher rates of C-reactive protein elevation (49.2% versus 31.8%; P < 0.0001), and higher health care utilization compared with nonantibiotic-exposed patients.
  
  
  CONCLUSIONS
  The majority of patients with IBD receive antibiotic treatment, and these individuals demonstrate a more severe clinical course.
authors: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors: Jana G
authors: JG
authors: Hashash
authors: Preethi
authors: P
authors: Chintamaneni
authors: Claudia M
authors: CM
authors: Ramos Rivers
authors: Ioannis E
authors: IE
authors: Koutroubakis
authors: Miguel D
authors: MD
authors: Regueiro
authors: Leonard
authors: L
authors: Baidoo
authors: Jason M
authors: JM
authors: Swoger
authors: Arthur
authors: A
authors: Barrie
authors: Marc
authors: M
authors: Schwartz
authors: Michael A
authors: MA
authors: Dunn
authors: David G
authors: DG
authors: Binion
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D008137:Longitudinal Studies; D008297:Male; D064307:Microbiota; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D002097:C-Reactive Protein