Antibiotic Use in Infants and Young Children May Increase Risk of Allergic Conditions

Children who received multiple courses of antibiotics between birth and 2 years of age were more likely to develop allergic conditions—such as food allergies and allergic rhinitis—and asthma, according to data published in The Journal of Infectious Diseases. Additionally, the investigators of this study determined that the risks of most autoimmune, neurodevelopmental, and psychiatric conditions studied were minimal following antibiotic exposure in early childhood.¹

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Antibiotics are commonly prescribed to young children to treat certain conditions, such as pneumonia and ear infections. The treatments may disrupt the digestive microbiome at a significant time during a child’s development, the investigators noted. They cited prior research that demonstrated a microbiome disruption from antibiotic exposure, which can potentially lead to harmful or disruptive conditions as the child gets older.^1,2

With this information, the investigators conducted a retrospective cohort study to further examine this association in over 1 million babies from the UK. Electronic health records data from 1987 to 2020 were used to assess possible associations between antibiotic exposure and allergic, autoimmune, neurodevelopmental, or psychiatric conditions in children through age 12.^1,2

The primary exposure was antibiotic prescriptions between birth and 2 years of age. Outcomes included the following: diagnoses of chronic pediatric conditions, including asthmatic or allergic, autoimmune, and neurodevelopmental or psychiatric; and forearm fracture (negative control). Adjusted hazard ratios were estimated using multivariable Cox regression models that were adjusted for maternal, child, and area-based socioeconomic status. Additionally, a sibling-matched analysis was conducted using conditional Cox regression.¹

Among the total 1,091,449 children enrolled, antibiotic exposure before 2 years of age was positively associated with allergic conditions, particularly food allergy (HR, 1.33 [95% CI 1.26-1.40]), allergic rhinitis (HR 1.06; 95% CI 1.03-1.10), and asthma (HR, 1.24 [95% CI 1.22-1.26]). Specifically, stronger associations were observed following multiple antibiotic courses, the authors noted. Findings from the sibling-matched analyses were considered to be similar.¹

“Antibiotics play a critical role in combatting bacterial infections, but physicians should be judicious when prescribing antibiotics to children under 2 [years], as frequent use may affect long-term health outcomes,” lead study author Daniel Horton, core member of the Center for Pharmacoepidemiology and Treatment Science, Rutgers Institute for Health, Health Care Policy and Aging Research, said in a news release.²

Further, early-childhood antibiotic exposure was observed to be dose-dependently associated with intellectual disability (5+ vs. 1-2 courses: HR, 1.73 [95% CI 1.49-2.01]; sibling-matched: HR, 2.79 [95% CI 1.87-4.18]); however, this was not observed with autoimmune diseases (e.g., celiac disease, inflammatory bowel disease, juvenile idiopathic arthritis, psoriasis, type 1 diabetes) and neurodevelopmental or psychiatric disorders (e.g., attention-deficit/hyperactivity disorder, autism spectrum disorders, and anxiety). Sibling-matched results and a negative control outcome also suggested there was a minimal confounding bias present.¹

“Antibiotics are important and sometimes life-saving medicines, but not all infections in young kids need to be treated with antibiotics,” said Horton, who is also an associate professor of pediatrics and epidemiology at Rutgers Robert Wood Johnson Medical School and Rutgers School of Public Health. “Parents should continue to consult with their children’s doctors on the best course of care.”²

REFERENCES

1. Beier MA, Setoguchi S, Gerhard T, et al. Early childhood antibiotics and chronic pediatric conditions: a retrospective cohort study. J. Infect. Dis. 2025;jiaf191. doi:10.1093/infdis/jiaf191

2. Rutgers University. Frequent use of antibiotics in infants and young children may increase risk for asthma, allergies and other conditions. News release. April 16, 2025. Accessed April 16, 2025. https://www.eurekalert.org/news-releases/1080773