title: The relationship between prior antimicrobial prescription and meningitis: a case-control study.
abstract: BACKGROUND
  Recent research into the role of the human microbiome in maintaining health has identified the potentially harmful impact of antimicrobials.
  
  
  OBJECTIVE
  The association with bacterial and viral meningitis following antimicrobial prescription during the previous year was investigated to determine whether antimicrobials have a deleterious effect on the nasopharyngeal microbiome.
  
  
  METHODS
  A case-control study (1:4 cases to controls) was conducted examining the rate of previous antimicrobial exposure in cases of meningitis and in a matched control group. Data from a UK primary care clinical database were analysed using conditional logistic regression.
  
  
  RESULTS
  A total of 7346 cases of meningitis were identified, 3307 (45%) viral, 1812 (25%) bacterial, and 2227 (30%) unspecified. The risks of viral (adjusted odds ratio [AOR] 2.45; 95% confidence interval [CI] = 2.24 to 2.68) or bacterial (AOR 1.98; 95% CI = 1.71 to 2.30) meningitis were both increased following antimicrobial prescription in the preceding year. Patients who received ≥4 antimicrobial prescriptions in the preceding year were at significantly increased risk of all types of meningitis (AOR 2.85; 95% CI = 2.44 to 3.34), bacterial meningitis (AOR 3.06; 95% CI = 2.26 to 4.15) and viral meningitis (AOR 3.23; 95% CI = 2.55 to 4.08) compared to their matched controls.
  
  
  CONCLUSIONS
  There was an increased risk of meningitis following antimicrobial prescription in the previous year. It is possible that this increase was due to an effect of antimicrobials on the microbiome or reflected an increased general susceptibility to infections in these patients.
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London.
authors.forename: David
authors.initials: D
authors.lastname: Armstrong
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London.
authors.forename: Mark
authors.initials: M
authors.lastname: Ashworth
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London.
authors.forename: Alex
authors.initials: A
authors.lastname: Dregan
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London.
authors.forename: Patrick
authors.initials: P
authors.lastname: White
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage*; D016022:Case-Control Studies; D006801:Humans; D016015:Logistic Models; D016920:Meningitis, Bacterial / Q000453:epidemiology / Q000276:immunology*; D008587:Meningitis, Viral / Q000453:epidemiology / Q000276:immunology*; D009305:Nasopharynx / Q000276:immunology* / Q000382:microbiology / Q000821:virology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000890:Anti-Infective Agents
keywords: antimicrobial agents; case-control studies; meningitis; microbiome; primary care