News article

Is antibiotic treatment in early life linked to earlier recurrence of diarrhoea?

Posted:  Monday, July 11, 2016

Will antibiotic exposure reduce time to the next diarrhoea episode in young children?

Diarrhoea, a recurrent disease in young children, is highly prevalent in low- and middle-income countries. According to the World Health Organization (WHO), diarrhoea is defined as at least three loose or watery stools in a 24-hour period. A new episode of diarrhoea is defined only after at least 48 hours of normal bowel movements since the previous episode. Antibiotics are usually prescribed for the treatment of diarrhoea, even though several organisations, including WHO, have advised against this practice. Antibiotics disturb gastrointestinal (GI) microbiota; this is a major concern, and may increase the risk of recurrent diarrhoeal episodes.

A prospective cohort study focussing on the immune responses of young children to cryptosporidiosis was published in the International Journal of Epidemiology. The study investigated the effects of antibiotic treatment on the timing of recurring diarrhoea in young children. Out of the 497 children, 434 were reported to have had at least one episode of diarrhoea. In the first 3 years of life, 61.8% of the children were administered one antibiotic course; while 35.5% were administered 2 or more antibiotic courses for the treatment of diarrhoea. Children who received antibiotics were mostly from a lower socio-economic background (n=282, 65%) and more likely from households with poor hygiene (n=210, 48.4%).

The antibiotic treatment for diarrhoea was correlated with the older age of the children at the time of the episode, and increased severity and duration of the diarrhoea. In comparison to the children who did not receive any antibiotics, the children who were treated with antibiotics for the first episode of diarrhoea had their second episode 8 weeks earlier, and the 3rd episode occurred 7 weeks earlier. Antibiotics had a lesser effect on the duration of later episodes (more than 4). The effect of antibiotics was more prominent in children under 6 months of age compared to those aged 6 months to 1 year, and older than one year. Cotrimoxazole was the most commonly administered antibiotic, followed by cefixime, while fluoroquinolones, penicillin, and macrolides were less commonly administered as reported by caregivers.

The study concluded that exposure to antibiotics early in life may shorten the duration of the subsequent diarrhoeal episode, especially among younger infants. These findings are in contradiction to the commonly held belief that antibiotics are not harmful. While the rational use of antibiotics has been recommended for reducing antimicrobial resistance, this study has demonstrated that the overuse of antibiotics may also have a direct negative impact on individual patients.

News source - Rogawski ET, Westreich DJ, Becker-Dreps S, Adair LS, Sandler RS, Sarkar R, Kattula D, Ward HD, Meshnick SR, Kang G. Antibiotic treatment of diarrhoea is associated with decreased time to the next diarrhoea episode among young children in Vellore, India. International journal of epidemiology. 2015 Jun 1; 44(3):978–87.