September 29, 2014

expert reaction to broad-spectrum antibiotics in infants and obesity in children

A paper published in JAMA Paediatrics has reported an association between treatment of infants with broad-spectrum antibiotics, and obesity later in childhood, with a greater effect from cumulative antibiotic use. The authors suggest that the effect may be limited by the use of more narrow antibiotics.

Dr Kieran Hand, Consultant Pharmacist in Antimicrobials, Royal Pharmaceutical Society, said:

“Although this study does not prove a causal link with obesity, it’s striking that in population of children receiving frequent antibiotics, those receiving broad-spectrums were at higher risk of obesity. There is a plausible link between antibiotics and obesity from research in animals. It’s a timely reminder that we shouldn’t be giving antibiotics to people with self-limiting viral illnesses who will be exposed to side effects without any clinical benefits.”

Dr Graham Burdge, Reader in Human Nutrition, University of Southampton, said:

“The study by Bailey et al. investigated whether there is a link between obesity in childhood and treatment with antibiotics in infancy.  Unfortunately, the design of the study, like those which preceded it, did not allow testing as to whether antibiotic use during infancy causes obesity in childhood, only that there may be an association.  The authors have been careful to clarify this in their hypothesis.  To date, there is no direct evidence to support a causal relationship between the effect of antibiotics on gut bacteria and obesity.  Hence, this study adds to a small number of other investigations which suggest that there is something about children who receive antibiotics in infancy that may make them more likely to become obese.  Importantly, the study did not include any assessment of the dietary or exercise habits of the children, nor of their socio-economic status (which has been linked inversely to risk of obesity in a number of studies).  Although the authors acknowledge these limitations, these omissions confound the findings of the study.  It would be a concern if parents took from this that they ought to be reluctant to allow antibiotic use in their children.  The key risk factors for childhood obesity are over-consumption of high energy, nutrient poor foods and lack of exercise.”

Professor Nigel Brown, President, Society for General Microbiology, said:

“This study adds further evidence that the use of antibiotics early in life has a role to play in obesity. While antibiotic use is only one factor that may predispose children to be obese, the study emphasises the importance of rapid diagnostic tests that allow precise targeting of antibiotics, which will kill the disease-causing bacteria and cause minimum disruption to the normal gut flora. In the absence of such diagnostic tests to identify the exact pathogen causing the disease, broad-spectrum antibiotics have to be used to protect the child. These broad-spectrum antibiotics are indiscriminate, and may kill helpful bacteria in the gut as well as those that cause disease.  In addition to their potential role in obesity, it is also important that we try to limit their use if we are to prevent the spread of antibiotic resistance.”

Prof Nick Finer, Consultant Endocrinologist and Bariatric Physician, University College London Hospitals, said:

“This research on a large survey of children confirms previous findings that link early exposure to broad-spectrum antibiotics in children to obesity. The study suggest a dose response – i.e. the more exposure to antibiotics the greater the impact. While such studies cannot prove causation, the hypothesis that alterations in gut microbes happens as a result of broad spectrum antibiotics is plausible and fits in with much other research linking gut flora and obesity.  The research provides another argument against unnecessary antibiotic use in children, although of course in children with serious infection antibiotics can be life-saving and in such cases should not be withheld.”

‘Association of antibiotics in infancy with early childhood obesity’ by L. Charles Bailey et al. published in JAMA Paediatrics on Monday 29 September 2014. 

Declared interests

None declared