Childhood Antibiotic Exposure Linked to Increased Later IBD Risk
Childhood antibiotic exposure was associated with an increased risk of later inflammatory bowel disease (IBD), particularly Crohn’s disease (CD), according to findings from a systematic review and meta-analysis.
Investigators evaluated cohort and case-control studies assessing antibiotic exposure from younger than 1 year through 17 years of age and subsequent IBD development. MEDLINE and EMBASE were searched from inception through December 31, 2024. Eligible studies reported a hazard ratio, odds ratio, or risk ratio, and pooled estimates were calculated using a DerSimonian-Laird random-effects model.
The review identified 10 studies, including 8 studies with 2783 IBD cases that reported associations between childhood antibiotics and later IBD risk. Additional disease-specific analyses included 2 studies on CD and 1 study on ulcerative colitis.
In pooled analyses, any antibiotic exposure during childhood was associated with a 42% increased risk of later IBD compared with no exposure (risk ratio [RR], 1.42; 95% CI, 1.23-1.66). The association was stronger for CD, with a 59% increased risk (RR, 1.59; 95% CI, 1.39-1.81). Ulcerative colitis risk was also elevated, though to a lesser degree (RR, 1.23; 95% CI, 1.08-1.40).
Heterogeneity across studies was low to moderate, with I² values ranging from 0% to 35%. Funnel plots did not suggest publication bias, and Egger’s test results were nonsignificant across analyses. Adjustment for infections did not attenuate the observed association between childhood antibiotic exposure and IBD development.
According to the authors, “antibiotic use in early childhood may alter the developing microbiome and has been proposed as a risk factor for inflammatory bowel disease.” They concluded that “childhood exposure to antibiotics was associated with an increased risk of later IBD, particularly for CD.”
Reference
Størdal K, Andersen S, Mårild K, Larsson V, Imberg H. Systematic review and meta-analysis of childhood exposure to antibiotics and the subsequent risk of IBD. Inflamm Bowel Dis. 2026;32(5):990-997. doi:10.1093/ibd/izaf324
