Antibiotics may do more harm than good

The Pediatric Insider

© 2012 Roy Benaroch, MD

Add to the growing list of reasons antibiotics might not be good for you and your children: a recent study showing a statistical link between early ear infections and inflammatory bowel disease (IBD).

Researchers in the UK analyzed data from about a million children, looking specifically at the 750 who developed IBD (Crohn Disease and ulcerative colitis, mostly.) They then compared the kids with IBD to children without that diagnosis, and looked back at the frequency of prior ear infections. Ear infections are the most common diagnosis leading to the use of antibiotics in young children, so it was figured that more ear infection diagnoses were a good marker for more antibiotics.

Their analysis found that early ear infections increased the risk of IDB substantially, probably by about 80%. The highest risk was among children with the most ear infections, and among children with the earliest diagnoses. So more antibiotics, and earlier antibiotics, seem to be predictive of the later development of IBD.

IBD is a complex illness. It seems to be related to altered immune regulation in the gut and other tissues. It’s been speculated that the normal bacteria in the gut help with the early formation and control of the immune system.  Early antibiotics could indeed interfere with that process, and are a plausible trigger for IBD, at least in people who are genetically predisposed. There are probably other factors at work, too.

Indiscriminate antibiotic use is bad news. It contributes to the development of resistant superbugs, and may play a role in the development of obesity, allergic disease, and asthma. Insidious forces can sometimes encourage the perceived “quick fix” of an antibiotic prescription—including rushed doctors, exasperated parents, and a health care system that rewards “satisfaction” over health. If you want to protect your child from unnecessary antibiotics, you have to ask a few questions:

  • Is this antibiotic really necessary?
  • Are there other options?
  • Is it safe to wait?
  • If we do need an antibiotic, what’s the safest one to use?

And, of course, remember that prevention is always better than cure. Keeping your child up to date on vaccines—including influenza vaccination—prevents both bacterial infections and some viral infections that predispose to ear infections and other antibiotic temptations. Nursing, avoiding group care, avoiding second-hand smoke, and not bottle-propping—all of these can help prevent at least some ear and other infections.

There will be times when an antibiotic is a good idea—I don’t want parents to be afraid of them when they really are necessary. But parents and doctors both need to take an active, thoughtful role in deciding when antibiotics are really a good idea.

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5 Comments on “Antibiotics may do more harm than good”

  1. oldmdgirl Says:

    So, you think daycare is bad for children?


  2. Dr. Roy Says:

    Children in group care have more upper respiratory infections, ear infections, and episodes of vomiting and diarrhea. And they’re exposed to more antibiotics. (Plenty of studies on this, eg, from there on pubmed from the right you can see lots of similar links). Since this post was about antibiotics, I highlighted that one way to avoid antibiotics is to avoid group care.

    There is a silver lining: children who attend group care have more infections when they’re younger, but fewer infections when they’re older: What’s the net, long-term effect? I don’t think we know.


  3. Zan Says:

    Interesting…I had tons of ear infections as a child and multiple sets of tubes in my ears (8 or so I think). Though I do not have IBS I do have allergies to several types of antibiotics including sulfa and penicillin (and all the related ones -myacin, -cycline) and I have to be very careful. I now have a 4 1/2 month old daughter and want to be very careful about giving her antibiotics unless necessary such as with strep throat. Luckily, I was able to find a pediatrician willing to do white cell counts before medicating. I have had an antibiotic only once since 1998 when I developed the penicillin allergy (when I had a c-section for my daughter so I guess she has had antibiotics once too). I think the regular use of antibiotics contributed to the allergy but that may just be my paranoia acting up. My mom and sister also have allergies to sulfa.


  4. Dr. Roy Says:

    Just-published prosprective, observational study from Canada linking group care with increased risk obesity:


  5. Rivkah Chaya Says:

    Either a lot of information is missing here, or this is just idiotic. I had antibiotics numerous times as a child, but only once for an ear infection at age four, and another for an ear infection at age nine. All the rest for for strep, which for some reason I was especially prone to. Looking at my medical records for ear infections, and then extrapolating to antibiotic use, you would think I had them only twice in my whole childhood. Actually, I had them at least twice a year, from about age three on, and am now allergic to penicillin as a result. I stopped getting recurrent strep once I was about 13, but at age 15 or 16, I got my first UTI, and I had a series of those, treated with antibiotics. I don’t have Chrohn’s disease.

    However, that isn’t really my point. My point is that if you want to know about antibiotic use, that’s what you should look at, not a diagnosis, then assume that was the treatment. Second, looking at it this way, you cannot be sure that there is not a single factor, such as a single gene, or parental smoking, that causes both frequent ear infections, and IBD.


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