TY - JOUR
T1 - Early Antibiotic Exposure in Low-resource Settings Is Associated with Increased Weight in the First Two Years of Life
AU - Rogawski, Elizabeth T.
AU - Platts-Mills, James A.
AU - Seidman, Jessica C.
AU - John, Sushil
AU - Mahfuz, Mustafa
AU - Ulak, Manjeswori
AU - Shrestha, Sanjaya
AU - Soofi, Sajid B.
AU - Yori, Pablo Penataro
AU - Mduma, Estomih
AU - Svensen, Erling
AU - Ahmed, Tahmeed
AU - Lima, Aldo A.M.
AU - Bhutta, Zulfiqar
AU - Kosek, Margaret
AU - Lang, Dennis
AU - Gottlieb, Michael
AU - Zaidi, Anita
AU - Kang, Gagandeep
AU - Bessong, Pascal
AU - Houpt, Eric R.
AU - Guerrant, Richard L.
N1 - Publisher Copyright:
Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Objectives: The potential growth-promoting effects of antibiotics are not well understood among undernourished children in environments with high pathogen exposure. We aimed to assess whether early antibiotic exposure duration and class were associated with growth to 2 years of age across 8 low-resource sites in the MAL-ED birth cohort study. Methods: We followed 1954 children twice per week from birth to 2 years to record maternally reported antibiotic exposures and measure anthropometry monthly. We estimated the associations between antibiotic exposure before 6 months of age and weight-for-age and length-for-age (LAZ) z scores to 2 years. We assessed the impact of class-specific exposures and duration, and compared these results to effects of antibiotic exposures after 6 months of age. Results: Antibiotic use before 6 months of age was associated with increased weight from 6 months to 2 years, whereas associations with length were less consistent across sites and antibiotic classes. Compared to unexposed children, 2 or more courses of metronidazole, macrolides, and cephalosporins were associated with adjusted increases in weight-for-age of 0.24 (95% confidence interval (CI): 0.04, 0.43), 0.23 (95% CI: 0.05, 0.42), and 0.19 (95% CI: 0.04, 0.35) from 6 months to 2 years, respectively. Conclusions: Antibiotic use in low-resource settings was most associated with the ponderal growth of children who had multiple exposures to antibiotics with broad spectrum and anaerobic activity in early infancy. Opportunities for rational and targeted antibiotic therapy in low resource settings may also promote short-term weight gain in children, although longer-term physical growth and metabolic impacts are unknown.
AB - Objectives: The potential growth-promoting effects of antibiotics are not well understood among undernourished children in environments with high pathogen exposure. We aimed to assess whether early antibiotic exposure duration and class were associated with growth to 2 years of age across 8 low-resource sites in the MAL-ED birth cohort study. Methods: We followed 1954 children twice per week from birth to 2 years to record maternally reported antibiotic exposures and measure anthropometry monthly. We estimated the associations between antibiotic exposure before 6 months of age and weight-for-age and length-for-age (LAZ) z scores to 2 years. We assessed the impact of class-specific exposures and duration, and compared these results to effects of antibiotic exposures after 6 months of age. Results: Antibiotic use before 6 months of age was associated with increased weight from 6 months to 2 years, whereas associations with length were less consistent across sites and antibiotic classes. Compared to unexposed children, 2 or more courses of metronidazole, macrolides, and cephalosporins were associated with adjusted increases in weight-for-age of 0.24 (95% confidence interval (CI): 0.04, 0.43), 0.23 (95% CI: 0.05, 0.42), and 0.19 (95% CI: 0.04, 0.35) from 6 months to 2 years, respectively. Conclusions: Antibiotic use in low-resource settings was most associated with the ponderal growth of children who had multiple exposures to antibiotics with broad spectrum and anaerobic activity in early infancy. Opportunities for rational and targeted antibiotic therapy in low resource settings may also promote short-term weight gain in children, although longer-term physical growth and metabolic impacts are unknown.
KW - antibiotics
KW - growth
KW - low-resource settings
KW - pediatric enteric disease
UR - http://www.scopus.com/inward/record.url?scp=85020738999&partnerID=8YFLogxK
U2 - 10.1097/MPG.0000000000001640
DO - 10.1097/MPG.0000000000001640
M3 - Article
C2 - 28604514
AN - SCOPUS:85020738999
SN - 0277-2116
VL - 65
SP - 350
EP - 356
JO - Journal of Pediatric Gastroenterology and Nutrition
JF - Journal of Pediatric Gastroenterology and Nutrition
IS - 3
ER -