scholarly journals Dose, Timing, and Spectrum of Prenatal Antibiotic Exposure and Risk of Childhood Asthma

2020 ◽  
Author(s):  
Kedir N Turi ◽  
Tebeb Gebretsadik ◽  
Tan Ding ◽  
Andrew Abreo ◽  
Cosby Stone ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Broad Spectrum ◽  
Childhood Asthma ◽  
Antibiotic Use ◽  
Population Based ◽  
Antibiotic Exposure ◽  
Logistic Regression Models ◽  
Asthma Risk ◽  
Timing Of Exposure ◽  
Important Evidence

Abstract Background The potential for prenatal antibiotic exposure to influence asthma risk is not clear. We aimed to determine the effect of timing, dose, and spectrum of prenatal antibiotic exposure on the risk of childhood asthma. Methods We conducted a population-based cohort study of 84 214 mother–child dyads to examine the association of prenatal antibiotic exposure and childhood asthma using multivariable logistic regression models. Results Sixty-four percent of pregnant women received antibiotics. Prenatal antibiotic exposure was associated dose-dependently with increased odds of childhood asthma (adjusted odds ratio [aOR] for interquartile increase of 2 courses [interquartile range, 0–2], 1.26 [95% confidence interval {CI}, 1.20–1.33]). Among children exposed to at least 1 course in utero, the effect of timing at the first course was moderated by total maternal courses. Among pregnant women receiving a single antibiotic course, timing of exposure had no effect on childhood asthma risk. Among women receiving > 1 course, early exposure of the first course was associated with greater childhood asthma risk. Compared to narrow spectrum–only antibiotic use, broad spectrum–only antibiotic exposure was associated with increased odds of asthma (aOR, 1.14 [95% CI, 1.05–1.24]). There were effect modifications (P < .001) by maternal asthma on total courses, and on timing of the first course, significant only among those without maternal asthma. Conclusions Increased cumulative dose, early pregnancy first course, and broad-spectrum antibiotic exposure were associated with childhood asthma risk. Our study provides important evidence supporting judicious prenatal antibiotic use, particularly timing of use and choice of antibiotics, in preventing subsequent childhood asthma.

Maternal antibiotic use during pregnancy and asthma in children: population-based cohort study and sibling design

2021 ◽  
Vol 57 (1) ◽  
pp. 2000937
Author(s):  
Natalie C. Momen ◽  
Xiaoqin Liu
Keyword(s):  
Cohort Study ◽  
Childhood Asthma ◽  
Cox Regression ◽  
Antibiotic Use ◽  
Epidemiological Studies ◽  
Population Based ◽  
Hospital Treatment ◽  
Familial Factors ◽  
Asthma Risk ◽  
Using Data

Antibiotic use during pregnancy may affect asthma risk in offspring. However, epidemiological studies yielded conflicting findings, with an observed association possibly confounded by shared familial factors. We sought to assess the association between maternal antibiotic use during pregnancy and childhood asthma in the offspring, by accounting for time-stable familial factors.We conducted a population-based cohort study and sibling study using data from Danish nationwide registers, which comprised 407 804 liveborn singletons from 2005 to 2011. Antibiotic use during pregnancy was defined as at least one antibiotic prescription filled by the mother from 1 month prior to pregnancy up until delivery, identified in the National Prescription Registry. First-time asthma in the offspring was determined by hospital treatment or asthma medication treatment after age 5 years. We estimated hazard ratios (HRs) of asthma using Cox regression in the population-based cohort and stratified Cox regression in the sibling cohort.Approximately 36.5% of pregnant women redeemed antibiotic prescriptions. Antibiotic use during pregnancy was associated with childhood asthma in cohort analyses (HR 1.21, 95% CI 1.18–1.24), but not in sibling analyses (HR 0.96, 95% CI 0.90–1.03). In the population-based analyses, higher risks of asthma were seen with longer duration of maternal antibiotic use, a higher number of prescriptions and prescriptions of multiple types of antibiotics. All these associations disappeared in the sibling analyses.The associations observed by previous studies for prenatal exposure to antibiotics and offspring asthma risk are likely to be due to confounding factors shared within families.

scholarly journals Prenatal antibiotic exposure and childhood asthma: a population-based study

2018 ◽  
Vol 52 (1) ◽  
pp. 1702070 ◽  
Author(s):  
Keely Loewen ◽  
Barret Monchka ◽  
Salaheddin M. Mahmud ◽  
Geert 't Jong ◽  
Meghan B. Azad
Keyword(s):  
Childhood Asthma ◽  
Cox Regression ◽  
Antibiotic Use ◽  
Population Based ◽  
Sensitivity Analyses ◽  
Antibiotic Exposure ◽  
Physician Billing ◽  
Increased Risk ◽  
Before And After ◽  
The Impact

Antibiotic use during infancy alters gut microbiota and immune development and is associated with an increased risk of childhood asthma. The impact of prenatal antibiotic exposure is unclear. We sought to characterise the association between prenatal antibiotic exposure and childhood asthma.We performed a population-based cohort study using prescription records, hospitalisation records and physician billing claims from 213 661 mother–child dyads born in Manitoba, Canada between 1996 and 2012. Associations were determined using Cox regression, adjusting for maternal asthma, postnatal antibiotics and other potential confounders. Sensitivity analyses evaluated maternal antibiotic use before and after pregnancy.36.8% of children were exposed prenatally to antibiotics and 10.1% developed asthma. Prenatal antibiotic exposure was associated with an increased risk of asthma (adjusted hazard ratio (aHR) 1.23, 95% CI 1.20–1.27). There was an apparent dose response (aHR 1.15, 95% CI 1.11–1.18 for one course; aHR 1.26, 95% CI 1.21–1.32 for two courses; and aHR 1.51, 95% CI 1.44–1.59 for three or more courses). Maternal antibiotic use during 9 months before pregnancy (aHR 1.27, 95% CI 1.24–1.31) and 9 months postpartum (aHR 1.32, 95% CI 1.28–1.36) were similarly associated with asthma.Prenatal antibiotic exposure was associated with a dose-dependent increase in asthma risk. However, similar associations were observed for maternal antibiotic use before and after pregnancy, suggesting the association is either not directly causal, or not specific to pregnancy.

Antibiotic exposure during pregnancy and childhood asthma: a national birth cohort study investigating timing of exposure and mode of delivery

2021 ◽  
pp. archdischild-2020-319659 ◽  
Author(s):  
Cecilie Skaarup Uldbjerg ◽  
Jessica E Miller ◽  
David Burgner ◽  
Lars Henning Pedersen ◽  
Bodil Hammer Bech
Keyword(s):  
Cohort Study ◽  
Caesarean Section ◽  
Birth Cohort ◽  
Childhood Asthma ◽  
Mode Of Delivery ◽  
First Trimester ◽  
Birth Cohort Study ◽  
Antibiotic Exposure ◽  
Exposure During Pregnancy ◽  
Timing Of Exposure

ObjectiveTo investigate whether antibiotic exposure during pregnancy was associated with childhood asthma and if this relationship was conditional on timing of exposure and mode of delivery.DesignA cohort study using multivariable logistic regression models adjusting for a priori defined confounders. Pregnant women were recruited from 1996 to 2002.SettingThe Danish National Birth Cohort.PatientsOf the 96 832 children in the cohort, 32 651 children were included in the study population.Main outcome measureParent-reported childhood asthma at 11 years.ResultsA total of 5522 (17%) children were born to mothers exposed to antibiotics during pregnancy. In adjusted analyses, children born to exposed mothers had higher odds of asthma (OR 1.14, 95% CI 1.05 to 1.24). There was no association with antibiotic exposure in the first trimester (OR 1.02, 95% CI 0.83 to 1.26), but higher odds were observed for antibiotic exposure in the second to third trimester (OR 1.17, 95% CI 1.06 to 1.28), compared with unexposed children. The overall association between antibiotics during pregnancy and childhood asthma was only observed in vaginally born children (OR 1.17, 95% CI 1.07 to 1.28) but not in caesarean section born children (planned caesarean section: OR 0.95, 95% CI 0.66 to 1.37; caesarean emergency: OR 0.96, 95% CI 0.73 to 1.28). In exposed vaginally born children, the odds for childhood asthma requiring treatment during the preceding year were 34% higher (OR 1.34, 95% CI 1.21 to 1.49), compared with unexposed vaginally born children.ConclusionsAntibiotic exposure in mid-to-late pregnancy is associated with higher odds of childhood asthma in vaginally born children. Mode of delivery may modify the association.

Antibiotic Use in a Canadian Province, 1995–1998

2000 ◽  
Vol 34 (4) ◽  
pp. 459-464 ◽  
Author(s):  
Anita G Carrie ◽  
Colleen J Metge ◽  
George G Zhanel
Keyword(s):  
Broad Spectrum ◽  
Antibiotic Use ◽  
Developed Countries ◽  
Population Based ◽  
Data Management System ◽  
Community Practice ◽  
Canadian Province ◽  
Population Based Study ◽  
Changing Patterns ◽  
Manitoba Health

OBJECTIVE: Antibiotics are among the most commonly used classes of agents in community practice; yet, studies of antibiotic use in this setting are scarce. Data from developed countries suggest increasing use of newer broad-spectrum agents, which has implications for the development of antibiotic resistance as well as cost of therapy. In this study, we quantified changing patterns of antibiotic use in community practice in Manitoba, Canada, from 1995 to 1998. DESIGN: A descriptive, population-based study of antibiotic use in Manitoba was facilitated by the Drug Programs Information Network (DPIN) of Manitoba Health; a data management system responsible for recording details of prescriptions dispensed for all Manitoba residents. Antibiotic use data, defined as numbers of prescriptions dispensed, were extracted from the DPIN from January 1, 1995, to March 31, 1998. Antibiotic use is reported as prescriptions per 1000 persons per year (Rx/1000/Yr) based on quarterly use. RESULTS: Penicillins (48.3%), macrolides (16.0%), and sulfonamides (12.5%) accounted for 75% of total antibiotic use; total use decreased 19.1% between 1995 and 1998. Use of the four most commonly prescribed agents decreased over the study period (amoxicillin, −17.4%; erythromycin, −29.0%; trimethoprim/sulfamethoxazole, −18.7%; penicillins G and V, −19.2%). In contrast, use of newer and/or broad-spectrum agents increased (ciprofloxacin, 21.9%; cefuroxime, 30.7%; and azithromycin/clarithromycin, 29.5%). Use of second-line agents as a percentage of total antibiotic use increased from 14.4% to 19.3% between January 1995 and March 1998 (p < 0.001). CONCLUSIONS: Penicillins, macrolides, and sulfonamides accounted for 75% of antibiotic use. Total antibiotic use declined over the study period; however, use of newer, broad-spectrum agents increased while use of older, narrow-spectrum agents decreased.

Is Appropriate Administration of Antenatal Corticosteroids Associated with Maternal Race?

2020 ◽  
Author(s):  
Devlynne S. Ondusko ◽  
Bharti Garg ◽  
Aaron B. Caughey ◽  
Rachel A. Pilliod ◽  
Emily H. Carter
Keyword(s):  
At Risk ◽  
Native American ◽  
Pregnant Women ◽  
Preterm Delivery ◽  
Population Based ◽  
Assisted Ventilation ◽  
Antenatal Corticosteroids ◽  
Chi Square ◽  
Logistic Regression Models ◽  
Maternal Race

Objective Antenatal corticosteroids (ACSs) improve outcomes for premature infants; however, not all pregnant women at risk for preterm delivery receive ACS. Racial minorities are less likely to receive adequate prenatal care and more likely to deliver preterm. The objective of this study was to determine if maternal race is associated with a lower rate of ACS administration in Washington for women at risk of preterm labor (between 23 and 34 weeks). Study Design This was a population-based retrospective cohort study of singleton, nonanomalous, premature deliveries in Washington state between 2007 and 2014. Descriptive data included maternal sociodemographics, pregnancy complications, facility of birth, and neonatal characteristics. The primary outcome was maternal receipt of ACS and the independent variable was maternal race/ethnicity. The secondary outcomes included neonatal need for assisted ventilation, both initially and for more than 6 hours, and administration of surfactant. Data were analyzed using chi-square tests and logistic regression models. Results A total of 8,530 nonanomalous, singleton neonates were born between 23 and 34 weeks' gestation. Of those, 55.8% of mothers were self-identified as white, 7.5% as black, 21.4% as Hispanic, 10.9% as Asian, and 4.3% as Native American. After adjusting for confounders, black woman–neonate dyads had significantly lower odds of receiving ACS, (adjusted odds ratio [aOR] = 0.62; 95% confidence interval [CI]: 0.51–0.76), assisted ventilation immediately following delivery (aOR = 0.76; 95% CI: 0.61–0.94) and for more than 6 hours (aOR = 0.64; 95% CI: 0.49–0.84) and surfactant therapy (aOR = 0.62; 95% CI: 0.42–0.92) as compared with whites. Conclusion These findings contribute to the current body of literature by describing racial disparities in ACS administration for pregnant women at risk for preterm delivery. To better understand the association between black race and administration of ACS, future studies should focus on differences within and between hospitals (including quality, location, resources), patient health literacy, social determinants of health, and exposure to systemic racism and discrimination. Key Points

scholarly journals Dose, Timing, and Type of Infant Antibiotic Use and the Risk of Childhood Asthma

2019 ◽  
Vol 70 (8) ◽  
pp. 1658-1665 ◽  
Author(s):  
Brittney M Donovan ◽  
Andrew Abreo ◽  
Tan Ding ◽  
Tebeb Gebretsadik ◽  
Kedir N Turi ◽  
...  
Keyword(s):  
Childhood Asthma ◽  
Clinical Decision Making ◽  
Antibiotic Prescription ◽  
Subsequent Development ◽  
Antibiotic Use ◽  
Healthy Children ◽  
Dependent Manner ◽  
Antibiotic Exposure ◽  
The Impact ◽  
Dose Dependent

Abstract Background Aspects of infant antibiotic exposure and its association with asthma development have been variably explored. We aimed to evaluate comprehensively and simultaneously the impact of dose, timing, and type of infant antibiotic use on the risk of childhood asthma. Methods Singleton, term-birth, non–low-birth-weight, and otherwise healthy children enrolled in the Tennessee Medicaid Program were included. Infant antibiotic use and childhood asthma diagnosis were ascertained from prescription fills and healthcare encounter claims. We examined the association using multivariable logistic regression models. Results Among 152 622 children, 79% had at least 1 antibiotic prescription fill during infancy. Infant antibiotic use was associated with increased odds of childhood asthma in a dose-dependent manner, with a 20% increase in odds (adjusted odds ratio [aOR], 1.20 [95% confidence interval {CI}, 1.19–1.20]) for each additional antibiotic prescription filled. This significant dose-dependent relationship persisted after additionally controlling for timing and type of the antibiotics. Infants who had broad-spectrum-only antibiotic fills had increased odds of developing asthma compared with infants who had narrow-spectrum-only fills (aOR, 1.10 [95% CI, 1.05–1.19]). There was no significant association between timing, formulation, anaerobic coverage, and class of antibiotics and childhood asthma. Conclusions We found a consistent dose-dependent association between antibiotic prescription fills during infancy and subsequent development of childhood asthma. Our study adds important insights into specific aspects of infant antibiotic exposure. Clinical decision making regarding antibiotic stewardship and prevention of adverse effects should be critically assessed prior to use during infancy.

scholarly journals Coping With Diagnostic Uncertainty in Antibiotic Prescribing: A Latent Class Study of Primary Care Physicians in Hubei China

2021 ◽  
Vol 9 ◽  
Author(s):  
Chaojie Liu ◽  
Dan Wang ◽  
Lixia Duan ◽  
Xinping Zhang ◽  
Chenxi Liu
Keyword(s):  
Primary Care ◽  
Broad Spectrum ◽  
Primary Care Physicians ◽  
Latent Class ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Behavioral Patterns ◽  
Diagnostic Uncertainty ◽  
Logistic Regression Models ◽  
Broad Spectrum Antibiotics

Background: Misuse of antibiotics is prevalent worldwide and primary care is a major contributor. Although a clear diagnosis is fundamental for rational antibiotic use, primary care physicians often struggle with diagnostic uncertainty. However, we know little about how physicians cope with this situation and its association with antibiotic prescribing.Methods: A total of 583 primary care physicians were surveyed using the Dealing with Uncertainty Questionnaire. Their prescriptions (n = 949,181) over the year 2018 were retrieved retrospectively. Two categories of behavioral patterns of participants were identified based on latent class analyses (high vs. low openness and collaborativeness) in responding to diagnostic uncertainty. Multi-level logistic regression models were established to determine the associations between these behavioral patterns and antibiotic prescribing (overall and broad-spectrum antibiotics) for illness without an indication for antibiotics and those with a conditional indication for antibiotics, respectively, after adjustment for variations of patient (level one) and physician (level two) characteristics.Results: Most physicians reported open communications with their patients (80.96%), collected further information (85.08%), and referred patients to specialists (68.95%) in dealing with diagnostic uncertainly. More than half (56.95%) sought help from colleagues. Less than 20% acted on intuition or adopted a “wait and see” strategy. About 40% participants (n = 238) were classified into the group of low openness and collaborativeness in coping with diagnostic uncertainty. They were more likely to prescribe antibiotics for the recorded illness without an indication for antibiotics (AOR = 1.013 for all antibiotics, p = 0.024; AOR = 1.047 for broad-spectrum antibiotics, p &lt; 0.001), as well as for the recorded illness with a conditional indication for antibiotics (AOR = 1.226 for all antibiotic, p &lt; 0.001; AOR = 1.257 for broad-spectrum antibiotics, p &lt; 0.001).Conclusion: Low tolerance with diagnostic uncertainty is evident in primary care. Inappropriate and over antibiotic prescribing is shaped by physicians' coping methods of diagnostic uncertainty. Physicians' openness and collaborativeness in responding to diagnostic uncertainty is associated with lower antibiotic prescribing in primary care. Interventions targeting on better management of diagnostic uncertainty may offer a promising approach in reducing antibiotic use in primary care.

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