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Copyright © 2007 Massachusetts Medical Society. All rights reserved.
This population‐based study confirms previous studies that found an association between antibiotic use and development of childhood asthma.
Results from previous studies have been equivocal regarding the association between antibiotic use early in life and the development of asthma during childhood. To examine risk factors for asthma at age 7, Canadian investigators conducted a longitudinal cohort study using healthcare and prescription databases in Manitoba, Canada.
Among 13,116 children born in 1995, 65% received oral antibiotics during the first year (mostly broad spectrum). To control for reverse causation, children who were diagnosed with asthma during the first year were excluded. After controlling for gender, maternal history of asthma, number of siblings, urban or rural location, and number of healthcare visits, antibiotic use during the first year of life compared with no use was associated with significantly increased risk for developing asthma (odds ratios, 1.27 for 1–2 doses; 1.41 for 3–4 doses; and 1.74 for >4 doses). The association between asthma and antibiotic use was increased among children who lived in rural areas, children whose mothers did not have asthma, and children who did not live with a dog at home during the first year, especially among those who had received multiple doses. The association between asthma and broad‐spectrum antibiotic use was statistically significant; the association with narrow‐spectrum antibiotics was not. Children who received antibiotics for nonrespiratory infections were about twice as likely to have asthma at age 7 as children who had not used antibiotics.
The results of this population‐based study confirm those of previous studies that found an association between multiple doses of antibiotics and development of childhood asthma and provide yet another reason to avoid unnecessary use of antibiotics, particularly broad‐spectrum agents.
Published in Journal Watch Pediatrics and Adolescent Medicine July 18, 2007
Kozyrskyj AL, et al. Increased risk of childhood asthma from antibiotic use in early life. Chest 2007;131:1753–9.
One dose of oral dexamethasone was no different than placebo.
Bronchiolitis is the leading cause of hospitalization among infants in the U.S. Use of steroids for infants with bronchiolitis remains controversial because of the lack of high‐quality, sufficiently powered studies. In a multisite double‐blind clinical trial, researchers randomized 600 infants (age range, 2–12 months) who presented to an emergency department with no prior history of wheezing and a clinical picture consistent with moderate‐to‐severe bronchiolitis to receive either a single dose of oral dexamethasone (1 mg/kg) or placebo. The primary outcome was hospitalization 4 hours after drug administration.
The admission rate was virtually identical in the steroid and placebo groups (39.7% and 41.0%, respectively). No differences emerged in subgroup analyses of infants who were positive for respiratory syncytial virus, those younger than 6 months, or those with a history of eczema or family history of asthma. Length of stay for hospitalized infants and subsequent admissions in the 7 days after the intervention were similar in the two groups.
This likely represents the definitive study of the use of steroids for infants with bronchiolitis in the ambulatory care setting. For infants with no history of wheeze, steroids convey no benefit. These results are consistent with a recent American Academy of Pediatrics guideline, which indicated that corticosteroids should not be used to treat bronchiolitis routinely.
Published in Journal Watch General Medicine July 26, 2007
Corneli HM, et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med 2007;357:331–9.
Otorrhea persisted in fewer children who received trimethoprim/sulfamethoxazole rather than placebo for 6 weeks.
Chronic otitis media with purulent otorrhea draining through a tympanic membrane perforation or a tympanostomy tube is a stubborn condition that can lead to hearing loss and mastoiditis. Investigators in the Netherlands randomized 101 children (age range, 1–12 years) with otorrhea lasting 3 months or longer to receive oral trimethoprim/sulfamethoxazole (TMP/SMX, 18 mg/kg) or placebo twice daily for at least 6 weeks. All subjects had failed treatment with topical ear drops, short‐term systemic antibiotics, or both. Ninety percent had a history of tympanostomy tube placement. If otorrhea was still present at the 6‐week follow‐up visit, treatment was continued for another 6 weeks. Treatment was restarted if otorrhea recurred between 6 and 12 weeks. Most subjects in each group also received antibiotic ear drops.
At 6 weeks, otorrhea persisted in fewer children in the TMP/SMX group than in the placebo group (28% vs. 53%; number needed to treat, 4). The difference in otorrhea rates between groups was less pronounced at 12 weeks (32% vs. 47%) and minimal at 12 months (25% vs. 20%). Hearing levels, health‐related or ear‐related quality‐of‐life scores, and the number of children who received additional interventions were similar between groups. During the first 6 weeks, vomiting and diarrhea were more common in the TMP/SMX group (number needed to harm, 14). One child in each group developed mastoiditis; both were treated successfully. One child stopped TMP/SMX because of a rash. Complete blood count and hepatic and renal function tests were normal among all children at baseline, 6 weeks, and 12 weeks.
Recent studies have suggested that topical antibiotic/corticosteroid ear drops are more effective than short‐term oral antibiotics for acute and chronic otorrhea (Journal Watch Pediatrics and Adolescent Medicine Oct 4 2006). This study suggests that it might be worth trying long‐term TMP/SMX in children with chronically draining ears that don't respond to short‐term therapy before referring them to otolaryngology. Despite minimal adverse effects with the long‐term and relatively high TMP/SMX dose studied here, interval complete blood counts should be considered.
Published in Journal Watch Pediatrics and Adolescent Medicine July 11, 2007
van der Veen EL, et al. Effectiveness of trimethoprim/sulfamethoxazole for children with chronic active otitis media: a randomized, placebo‐controlled trial. Pediatrics 2007;119:897–904.
Conceiving with a new partner might increase the risk for gastroschisis.
An increase in the rate of gastroschisis (a congenital defect of the abdominal wall) has been noted in several population‐based studies. Gastroschisis usually is a sporadic event and is thought to be related to vascular compromise in the developing fetus. In a case‐control study, researchers examined whether change of paternity might be a risk factor for gastroschisis.
Pregnancies of 102 mothers of infants with isolated gastroschisis were compared with pregnancies of 117 mothers of non‐malformed infants and 78 mothers of infants with neural tube defects or oral clefts. Change of paternity was significantly more common among case mothers than among mothers in the comparison groups. In multivariate analysis adjusted for maternal age, the odds ratio for change in paternity among mothers of infants with gastroschisis was 7.8.
This research raises a fascinating question about whether a change of reproductive partner plays a role in the development of birth defects, theoretically because the mother has an immune response to the new paternal antigens or to the fetus with the new partner's genes. Although the exact mechanism is uncertain, the findings suggest that immune recognition may affect blood vessels in the developing embryo or fetus. This study clearly needs to be repeated and the association between change in paternity and other birth defects needs to be examined. If the results are confirmed for gastroschisis or other birth defects, a thorny issue will arise concerning the role of multiple sexual partners in the development of birth defects and the increased risk among offspring of second and subsequent marriages.
Published in Journal Watch Pediatrics and Adolescent Medicine July 18, 2007
Chambers CD, et al. Novel risk factor in gastroschisis: change of paternity. Am J Med Genet A 2007;143:653–9.