HYANNIS – There are instances when infants need antibiotics, but new research suggests that prescribing them too often may contribute to childhood obesity.
A study published in the January issue of the journal, Gut, looked at more than 333,000 children on TRICARE military medical coverage born between October 2006 and September 2013. Nearly 73 percent were prescribed an antibiotic by age 2, and those children were 26 percent more likely to become obese than those who didn’t receive an antibiotic. An association with obesity was found to a lesser extent in children under 2 given either of two types of acid-suppressing medicines, proton-pump inhibitors and histamine-2 receptor antagonists.
The study’s authors postulated that all these drugs harm the beneficial bacteria that live in the intestines (part of the gut microbiome), resulting in greater risk of obesity.
Antibiotics often disrupt digestion, causing diarrhea and an upset stomach, said Janelle Laudone, MD, a pediatric hospitalist at Cape Cod Hospital. But she stressed that the study found an association, and did not prove that the drugs caused obesity.
There are too many factors involved in the national epidemic of obesity to single out antibiotics as a main cause, she said.
Antibiotics are also overprescribed, said Dr. Laudone, which is an issue health experts have been trying to address. Overuse of antibiotics weakens their effectiveness, as disease-causing bacteria develop resistance to these drugs, according to the Centers for Disease Control and Prevention. That, in turn, leaves doctors with fewer weapons to fight bacterial infections.
“We all know antibiotics can be lifesaving,” she said. “(But) we have to be aware there is a problem with the overuse of these medications.”
Choose Wisely
In response to this and other treatment issues, the American Board of Internal Medicine developed a program called Choosing Wisely that encourages physicians and patients to discuss treatments and tests and select those that are supported by scientific evidence and avoid those that may be duplicative, unnecessary or harmful. In accordance with this program, the American Academy of Pediatrics has adopted several guidelines, which Dr. Laudone said advise refraining from treating colds and other viral respiratory infections with antibiotics, and not using acid blockers for routine gastroesophageal reflux in infants.
“Babies spitting up is a common and normal thing,” she said. As long as the baby is otherwise healthy and not in pain, treatment of these “happy spitters” is not necessary.
Other studies have shown a greater risk of infection with acid suppressors, according to Dr. Laudone. “One function of stomach acid is to kill bacteria.”
The study in Gut showed that nearly three-quarters of children under 2 were treated at least once with antibiotics. Despite this high amount of treatment, “a lot of infections infants get are viral, such as nasal congestion and cough,” she said. Ear infections often go away without antibiotics, she said, and may be treated with acetaminophen for discomfort.
When antibiotics are called for, narrow-spectrum drugs that target the problem bacteria are preferred to a broad-spectrum drug, according to Dr. Laudone.
As far as restoring the gut microbiome in your child’s intestinal tract, Dr. Laudone stopped short of advocating the use of probiotics in children who have recently finished a course of antibiotics.
“There is conflicting evidence about the use of probiotics and there are many different formulations available. I would recommend that parents talk to their doctor before starting your child on a probiotic,” she said.
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