Some Antibiotics Linked To Increased Risk of Kidney Stones Interview with:

A kidney stone (yellow) composed of calcium oxalate: Wikipedia Image

A kidney stone (yellow) composed of calcium oxalate: Wikipedia Image

Gregory Tasian MD, MSc, MSCE
Assistant Professor of Urology and Epidemiology
University of Pennsylvania Perelman School of Medicine
Division of Urology and Center for Pediatric Clinical Effectiveness
The Children’s Hospital of Philadelphia What is the background for this study? What are the main findings?

Response:  We found that five classes of commonly prescribed antibiotics were associated with an increased risk of kidney stones. These classes were sulfa drugs (e.g. Bactrim), fluoroquinolones (e.g. Cipro), cephalosporins (e.g. cephalexin), nitrofurantoin, and broad-spectrum penicillins (e.g. augmentin).  For those five classes of antibiotics, the greatest risk was found among younger patients. However, the increased risk was still significant across all ages, including for older adults with the exception of broad-spectrum penicillins, which were not associated with an increased risk of kidney stones among patients >75 years of age.

We conducted this study because:

1) Prior investigations have demonstrated that changes in the gut microbiome were associated with kidney stones,

2) Antibiotics are prescribed frequently, and

3) The number of people affected by kidney stone disease has increased 70% over the last 30 years and the greatest increases have been found among children and adolescents.

Our results were consistent with these previous studies, so we were not surprised with the findings although we did not know which specific classes of antibiotics would be associated with an increased risk of stones and which ones would not. What should readers take away from your report? 

Response: Without a doubt, antibiotics have saved millions of lives and are needed to prevent death and serious harm from infections; the benefits outweigh the potential harms. These results don’t suggest that antibiotics should not be prescribed when indicated. However, they do support antibiotic stewardship- the judicious and appropriate use of antibiotics and reducing inappropriate use of antibiotics (e.g. for a viral illness). They also may help guide choice of antibiotics when alternatives exist, particularly for those patients at risk of kidney stones (e.g. prior history of stones, high risk medications, or have underlying conditions that increase stone formation). What recommendations do you have for future research as a result of this work? 

Response: Our group is characterizing the types of gut bacteria and their metabolic “signatures” in children and adolescents with and without calcium oxalate kidney stone disease (the most common type of stones) with the goal of identifying how the community of organisms and their metabolic products are disrupted in patients with nephrolithiasis.

These studies may provide additional insight into how, ultimately, we might be able to restore a healthy microbiome or mitigate the adverse changes that exposure to certain antibiotics cause. Is there anything else you would like to add?

Response: This study has identified a potential new risk factor for kidney stones. These results may help explain the rapid increase in the incidence of kidney stone disease, particularly among children and adolescents.

No relevant disclosures. 


Gregory E. Tasian, Thomas Jemielita, David S. Goldfarb, Lawrence Copelovitch, Jeffrey S. Gerber, Qufei Wu, Michelle R. Denburg. Oral Antibiotic Exposure and Kidney Stone Disease. Journal of the American Society of Nephrology, 2018; ASN.2017111213 DOI: 10.1681/ASN.2017111213

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Last Updated on May 15, 2018 by Marie Benz MD FAAD