Antibiotics In Infancy and Childhood Asthma, Viral Infections

Adnan Custovic DM MD PhD FRCP Professor of Allergy Institute of Inflammation and Repair University of Manchester University Hospital of South Manchester Manchester M23 9LT, UKMedicalResearch.com Interview with:
Adnan Custovic DM MD PhD FRCP
Professor of Allergy
Institute of Inflammation and Repair
University of Manchester
University Hospital of South Manchester
Manchester M23 9LT, UK

MedicalResearch: What are the main findings of the study?

Dr. Custovic: In a longitudinal analysis of the data from our birth cohort study collected from birth to age eleven years, we demonstrated an association between early-life antibiotic prescription and development of wheezing, but not atopy. Furthermore, amongst children with wheezing, antibiotic prescription in infancy increases the risk of subsequent severe wheeze/asthma exacerbations and hospital admissions. This is the first demonstration that children who receive antibiotics in infancy have impaired antiviral immunity later in life, and that early-life antibiotic prescription is associated with variants on chromosome 17q21 locus (which is an asthma susceptibility locus).

Our findings suggest that the association between antibiotics and childhood asthma reported in previous studies arises through a complex confounding by indication, in which hidden factors which increase the likelihood of both antibiotic prescription in early life and subsequent asthma development are increased susceptibility to virus infections consequent to impaired antiviral immunity, and genetic variants on 17q21. Our results raises an important issue that effects which are often attributed to environmental exposures may be a reflection of genetic predisposition.

MedicalResearch: Were any of the findings unexpected?

Dr. Custovic: Yes, both the demonstration that children who receive antibiotics in the first year of life have impaired antiviral immunity later in life, and that early-life antibiotic prescription is associated with genetic variants on chromosome 17q21 locus.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Custovic: Given the inappropriate prescribing of antibiotics (and the development of resistance which this may be causing), when primary care physicians are considering the need to prescribe antibiotics for respiratory infections amongst wheezy children, they can take some reassurance from our data showing that while antiviral immunity may be impaired amongst children who were prescribed antibiotics in early life, antibacterial immunity is not.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Custovic: Future studies should take into account the possibility that environmental exposures may not occur at random, but may be dependent on subject’s genotype (such as early-life antibiotic prescription occurring more commonly amongst children with specific 17q21variants). Also, whether impaired antiviral immunity predated antibiotic use making antibiotic prescription more likely (which is suggested by our data), or whether it is also a consequence of antibiotic use, will require further studies monitoring antiviral immunity throughout early and later childhood.

Citation:

Assessing the association of early life antibiotic prescription with asthma exacerbations, impaired antiviral immunity, and genetic variants in 17q21: a population-based birth cohort study
Aida Semic-Jusufagic MD,Danielle Belgrave PhD,Prof Andrew Pickles PhD,Aurica G Telcian MD,Eteri Bakhsoliani MSc,Annemarie Sykes MD,Prof Angela Simpson MD,Prof Sebastian L Johnston MD,Prof Adnan Custovic MD
The Lancet Respiratory Medicine – 15 May 2014
DOI: 10.1016/S2213-2600(14)70096-7