Antibiotic Use in Infants May Up Asthma Risk

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Two-thirds of the youngsters had received at least one antibiotic prescription during their first year of life, many of them for broad-spectrum antibiotics, according to the study. And, the more antibiotics received, the greater the risk of asthma.

Kids who received one to two courses of antibiotics had a 21 percent increased risk of asthma; those given three to four courses of antibiotics had a 30 percent rise in risk; while youngsters given more than four courses of antibiotics had a 46 percent increased risk of asthma.

Children given antibiotics for non-respiratory tract infections, such as urinary-tract infections, were as much as 86 percent more likely to develop asthma than those treated for respiratory infections.

Other factors that increased the risk of asthma included a family history, living in an urban area and being male. Having a sibling conferred a slight protective effect, as did having a dog for children who received multiple courses of antibiotics. In kids who had more than four courses of antibiotics before age 1, having a dog decreased the risk of asthma by 28 percent. However, in kids who received fewer antibiotics, that protective effect wasn't there.

Dr. Alan Khadavi, a pediatric asthma specialist at New York University Medical Center, said that prevention of asthma isn't a reason to get a dog. "If you already have a dog, that's fine, but the studies are conflicting about whether they're helpful or harmful," he added.

As for antibiotic use, Khadavi said, "If your child under 1 year is sick, have him or her evaluated. Don't push for antibiotics. But. on the other hand, if it's a serious infection that needs to be treated, I wouldn't worry too much about the asthma risk. If it's a mild infection, a watch-and-wait approach won't be harmful if they're under a physician's care."

Dr. Sai Nimmagadda, an attending physician in the division of allergy at Children's Memorial Hospital in Chicago, said this study points to the need for "more judicious use of antibiotics, especially broad-spectrum antibiotics in kids under a year."

"Once wheezing has developed, it's difficult to alter the course of asthma, so now we're looking back to see if there are any risk factors we can change," he said.

Kozyrskyj recommended that physicians start by prescribing narrow-spectrum antibiotics, such as amoxicillin, for their youngest patients, and then if necessary, try a broad-spectrum medication.

More information

To learn more about childhood asthma, visit the American Lung Association.