PM2048: Associations Between Antibiotic Subtype and Childhood Disease

Background: Growing evidence suggests that early antibiotic exposure alters the infant gut microbiota and increases the risk of developing childhood diseases, including asthma, allergies, and eczema. While the relationship between the use of general antibiotics in early childhood and subsequent disease development has been extensively studied, it remains unclear how specific antibiotic subtypes (for example ampicillin vs azithromycin vs doxycycline) alter disease risk.

Methods: A retrospective electronic chart review for pediatric patients born in the Loyola Healthcare system between 2007-2021 who had at least 2 subsequent visits was performed. Disease status was obtained using ICD-10 codes and confounding factors were controlled for (age, gender, race, poverty level, and birthweight). 49 sub-types of antibiotics were identified and perscribed within our cohort. Of the 9711 babies in our initial cohort, 9238 babies were included in our final analysis after excluding patients with missing covariates (birthweight and zip code). 7% (717/9238) had asthma, 5% (558/9238) had allergic rhinitis, 3.5% (343/9238) had eczema, and 4.6% (449/9238) were diagnosed with obesity. Multivariate logistic regression was performed between antibiotic subtypes and diseases known to be associated with early antibiotic exposure (asthma, allergic rhinitis, eczema, and obesity).

Results: Patients prescribed amoxicillin-clavulanate combination therapy were 26% more likely to have asthma (OR = 1.26, p< 0.001), 24% more likely to have allergic rhinitis (OR = 1.24, p< 0.001), and 12% more likely to be obese (OR = 1.12, p < 0.001) when compared to patients never prescribed amoxicillin-clavulanate. Additionally, patients prescribed azithromycin were 13% more likely to develop asthma (OR = 1.12, p< 0.001) and 16% more likely to develop allergic rhinitis (OR = 1.16, p< 0.001), when compared to patients never prescribed azithromycin. Interestingly, there was no significant correlation between the use of any class of antibiotics and the development of eczema.

Conclusion: Our findings suggest that the use of certain antibiotic subtypes (i.e., amoxicillin-clavulanate and azithromycin) may alter the risk for childhood diseases including asthma, allergic rhinitis, and obesity. Additionally, there was no significant association between the use of antibiotics and the development of eczema. As the prevalence of atopic and allergic diseases continues to increase, it is important to understand how different antibiotic subtypes influence gut dysbiosis and to update pediatric best practices regarding antibiotic use accordingly.