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Global rates of antibiotic use vary depending on location,¹ but reports indicate that for children, the rates have increased in some areas.² In the US, while antibiotic use in children overall has been stable in the last decade, children under the age of one year showed significantly higher exposure than other age categories.³ A growing body of evidence reveals early-life antibiotic exposures may have long-term consequences such as increased risks of childhood obesity,^4,5 eczema and asthma,⁶ gut dysbiosis,⁷ and inflammatory bowel disease.⁸

Antibiotics & Pediatric Gut Health

Early-life antibiotic exposure is reportedly a significant stressor on the pre- and postnatal microbiome.⁹ A 2021 systematic review and meta-analysis of mostly observational studies found that maternal exposure to antibiotics during labor and delivery was associated with reduced microbial diversity in the infant’s intestinal microbiome.¹⁰ An additional systematic review and meta-analysis indicated that antibiotic exposure in children was associated with a short-term and at times long-term reduction in gut microbiome diversity, richness, and bacterial abundance, increasing the risk of dysbiosis.¹¹

Studies suggest that disruption to the gut microbiome due to increased exposure to early-life antibiotics is linked to the disruption of host immunity and the development of immune-related and metabolic disorders later in life.⁷ A 2023 cohort study out of Denmark found that oral antibiotic exposure during the first five years of life was associated with a 33% higher risk of developing pediatric inflammatory bowel disease, with significant associations shown for Crohn’s disease (HR=1.29; CI: 1.2-1.4).⁸ A 2019 meta-analysis of 19 studies (n=671,681 total participants) found that those children with antibiotic exposure in early life had a significantly increased odds of childhood weight gain and obesity (OR: 1.05; CI: 1:04-1:06).⁴

Clinical Applications: A Functional Medicine Approach

Research continues to expand our understanding of early-life antibiotic exposures and health impacts. As illustrated by the mentioned studies, currently, an overwhelming consensus links increased pediatric antibiotic use to increased risks of immune-based and metabolic conditions, and gut microbial disruptions appear to play a large role. It is important to note, as well, that there is individual variability among healthy microbiomes. Functional medicine is patient-centered rather than disease-centered, which is a particularly important distinction when it comes to gut microbiome research and application.

Clinicians who practice functional medicine seek to understand the antecedents, triggers, and mediators that underlie illness or dysfunction in each individual pediatric or adult patient. And understanding the role of early-life stressors such as the extent of pediatric antibiotic use in a patient’s health history may inform personalized treatment strategies. The functional medicine model prioritizes a therapeutic partnership between the patient and practitioner. Collaborating with patients not only helps practitioners clarify vital components of a patient’s life-long health story, but it can also present opportunities to expand a patient’s health knowledge and empowerment.

Read more about optimizing pediatric health through a functional medicine lens in the IFM-authored articles linked below. And learn more about enhancing the therapeutic partnership with your patients, evaluating for root causes of disease and health dysfunction, and personalizing sustainable treatment strategies at IFM’s Applying Functional Medicine in Clinical Practice (AFMCP)^TM.

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References

1. Browne AJ, Chipeta MG, Haines-Woodhouse G, et al. Global antibiotic consumption and usage in humans, 2000-18: a spatial modelling study. Lancet Planet Health. 2021;5(12):e893-e904. doi:1016/S2542-5196(21)00280-1
2. Allwell-Brown G, Hussain-Alkhateeb L, Kitutu FE, Strömdahl S, Mårtensson A, Johansson EW. Trends in reported antibiotic use among children under 5 years of age with fever, diarrhoea, or cough with fast or difficult breathing across low-income and middle-income countries in 2005-17: a systematic analysis of 132 national surveys from 73 countries. Lancet Glob Health. 2020;8(6):e799-e807. doi:1016/S2214-109X(20)30079-6
3. Petersen MR, Cosgrove SE, Quinn TC, Patel EU, Kate Grabowski M, Tobian AAR. Prescription antibiotic use among the US population 1999-2018: National Health and Nutrition Examination Surveys. Open Forum Infect Dis. 2021;8(7):ofab224. doi:1093/ofid/ofab224
4. Aghaali M, Hashemi-Nazari SS. Association between early antibiotic exposure and risk of childhood weight gain and obesity: a systematic review and meta-analysis. J Pediatr Endocrinol Metab. 2019;32(5):439-445. doi:1515/jpem-2018-0437
5. Li P, Chang X, Chen X, et al. Early-life antibiotic exposure increases the risk of childhood overweight and obesity in relation to dysbiosis of gut microbiota: a birth cohort study. Ann Clin Microbiol Antimicrob. 2022;21(1):46. doi:1186/s12941-022-00535-1
6. Räty S, Ollila H, Turta O, et al. Neonatal and early infancy antibiotic exposure is associated with childhood atopic dermatitis, wheeze and asthma. Eur J Pediatr. Published online September 28, 2024. doi:1007/s00431-024-05775-1
7. Kesavelu D, Jog P. Current understanding of antibiotic-associated dysbiosis and approaches for its management. Ther Adv Infect Dis. 2023;10:20499361231154443. doi:1177/20499361231154443
8. Jawad AB, Jansson S, Wewer V, Malham M. Early life oral antibiotics are associated with pediatric-onset inflammatory bowel disease-a nationwide study. J Pediatr Gastroenterol Nutr. 2023;77(3):366-372. doi:1097/MPG.0000000000003861
9. Brockway M. The role of antibiotic exposure and the effects of breastmilk and human milk feeding on the developing infant gut microbiome. Front Public Health. 2024;12:1408246. doi:3389/fpubh.2024.1408246
10.  Grech A, Collins CE, Holmes A, et al. Maternal exposures and the infant gut microbiome: a systematic review with meta-analysis. Gut Microbes. 2021;13(1):1-30. doi:1080/19490976.2021.1897210
11.  McDonnell L, Gilkes A, Ashworth M, et al. Association between antibiotics and gut microbiome dysbiosis in children: systematic review and meta-analysis. Gut Microbes. 2021;13(1):1-18. doi:1080/19490976.2020.1870402