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The Skin They're In
Associated Conditions and Mistreatment as Confounding Variables in Antibiotic Link with Asthma
Increased Risk of Childhood Asthma from Antibiotic Use in Early Life : The cause or the effect
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Mats Reimer, Community pediatrician Child Clinic Molnlycke SWEDEN
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reimer{at}telia.com Mats Reimer
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Children later developing atopic asthma often start their "career" with atopic dematitis in the first year of life. Atopic skin is very often colonized and sometimes infected by S.aureus. This is a possible confounder as antibiotic treatment for skin infection could be just a marker for atopy and not the cause of later asthma. |
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Maurice J. Chianese, M.D., F.A.P.P., Pediatrician Division of Pediatrics, ProHEALTH Care Associates, L.L.P., Lake Sucess, NY
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mchianese{at}prohealthcare.com Maurice J. Chianese, M.D., F.A.P.P.
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Although the findings of this study lead a practicing pediatrician to take pause, there may be some confounding variable, which, if considered, would alter the conclusions drawn form this data. Not infrequently, infants and toddlers who later are diagnosed with atopic asthma, have either more severe or protracted virally-induced respiratory illnesses. During these episodes, these individuals are more likely to develop suppurative complications of their viral upper respiratory tract infections (otitis media and sinusitis), which would lead to antibiotic courses. Also, many of these infants and toddlers receive antibiotics during these virally-induced respiratory episodes due to the mistaken conclusion that their abnormal lung finding are due to bacterial etiologies (pneumonia or "wheezy bronchitis"). This is especially the case for individuals without a family history of asthma or other atopic disorders, who would be less likely to be considered asthmatic at early in life. Given these common indications for the use of antibacterial therapy, which are intrinsically linked to these individuals' increased airway inflammation and reactivity, it would not be surprising to find that such individuals were more likely to have had multiple courses of antibiotics early in life and a diagnosis of atopic asthma at seven years-of-age. |
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Hundie Tesfaye, Physician Consultant, Division of Clinical Pharmacology
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hundie.tesfaye{at}fnmotol.cz Hundie Tesfaye
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The authors, Kozyrskyj et colleagues brought in to attention a very interesting epidemiologic aspect of the problem. Unfortunately, the findings may not affect any how the approach of antibiotic prescription in early age provided that the diagnosis is right for the right use of even a broad-spectrum antibiotic. This problem is more complex than relatively clear epidemiologic approach. The main challenge is interpretation of the causality relationship between broad spectrum (BS) antibiotic use in early life and onset of asthma at later age. Here the question is almost somewhat like „ Is it an egg or a hen that comes first? “. The right diagnosis and differential diagnosis process is often very challenging since viral infection may be followed by bacterial infection leading to further complication. At the very beginning, infants with troublesome, repeated infection episodes need antibiotic therapy to ovoid further damage to respiratory tract under culture confirmed invasive bacteria. The fact that some of these infants developed asthma in later life (at age of seven years) does not necessarily mean the antibiotic use itself induced asthma to develop. Rather, individuals who reasonably required frequent BS antibiotics therapy might be the most probable candidates to develop asthma in future life compared to those who did not required such antibiotics. However, it may be worthful to conduct such studies not exclusively on pharmacoepidemiological basis adhering to antibiotics prescription data analysis, but in relation to clinical approach especially targeting analysis of the clinical states including differential diagnosis, which made antibiotic therapy inevitable or mandatory at time. Nevertheless, the issue is very important and needs further elucidations based on more evidences. |
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