A recent JAMA Pediatrics study has identified an association between antibiotic treatment 0-6 mo of age and risk of allergic diseases like food allergy, hay fever, eczema, and especially asthma. The research looked at almost 800,000 infants from 2001-13 who subsequently received >160,000 prescriptions for antibiotics, finding the highest risk for penicillins and lower but significant risks for cephalosporins and sulfa drugs. Asthma incidence increased by 47%, and multiple prescriptions–especially with different drugs– in that age group “upped the ante” on those risks.
Researchers and allergists speculate that use of antibiotics alters “the microbiome”which can disrupt the natural protective properties of those intestinal bacteria. Disrupting that balance, they postulate, interferes with normal body immune development which can explain the study’s findings. I will stress that this study demonstrates an association. In other words, it may be showing that taking antibiotics in infancy increases the risk of allergic disease, or that children with allergic diseases end up receiving antibiotics earlier and more frequently. We don’t know which for sure, but it certainly is important to keep in mind when we are considering prescribing antibiotics, especially in these little kids.
One aspect of this story that I wish to note is the frequency of antibiotic prescription at so called urgent care centers. Some studies report that 46% of patients received antibiotics for conditions that did not warrant their use; nationwide, 40% of all outpatient antibiotic prescriptions originate from urgent care encounters. The CDC estimates that, nationwide, 23,000 people die each year from antibiotic resistant bacterial infections with names like MRSA, “c dif,”, VRE, CRE. Many public health officials fear that, with antibiotic overuse, those numbers may explode into the millions in the decades to come.
To their credit, many urgent care center organizations are working diligently to improve their performance in that area by such initiatives as developing best practice protocols and partnering with organizations like the George Washington University Antibiotic Resistance Action Center to educate their providers about this issue. However, as the patients and their histories are not well known to these caregivers–who are often nurse practitioners or physician assistants with less experience and clinical training than MD’s or DO’s–making progress with this is a great challenge for these facilities.
I recommend exercising caution in utilizing urgent care centers for your children and in particular that age group–0-6 months. Generally if you can get the fever down (even if it goes back up later), your child has an appetite for fluids and is holding them down, urinating at least 3-4x/24 hours, then the situation is likely stable and can wait for the regular doctor’s office to open. Remember– fast does not necessarily equal good. I stress the term “generally”–OF COURSE each situation must be judged based on the condition of that particular child at that particular time.
But before rushing off to the urgent care center or the ER keep the above in mind and give me a call before you go. I’m here to help you make the best decision for your child.
Image courtesy of Children’s Healthcare of Atlanta. Thanks for following.