Patterns of antibiotic exposure and clinical disease activity in inflammatory bowel disease: A 4-year prospective study

Jana G. Hashash, Preethi Chintamaneni, Claudia M. Ramos Rivers, Ioannis E. Koutroubakis, Miguel D. Regueiro, Leonard Baidoo, Jason M. Swoger, Arthur Barrie, Marc Schwartz, Michael A. Dunn, David G. Binion*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Background: Antimicrobial treatment is known to cause short- and long-term changes in the composition of normal human microbiota. The relationship between antibiotic use and overall clinical behavior in inflammatory bowel disease (IBD) has not been explored. We aim to prospectively characterize patterns of antibiotic use and clinical IBD activity in a large IBD cohort. Methods: Prospective observational study from a longitudinal IBD natural history registry between 2009 and 2012. Antibiotic prescriptions were identified and categorized using electronic medical record data. Cumulative rates over the 4-year study period were compared. Demographic, clinical, laboratory, health care utilization, and treatment data of the patients with IBD were collected and analyzed. Quality of life was measured by Short IBD Questionnaire data. Primary outcomes were markers of disease activity including Short IBD Questionnaire scores, C-reactive protein levels, health care utilization, and medication use. Results: Seven hundred eighteen patients followed over 4 years were included (47.6% male; mean age, 46.7 ± 15.2 yr), 59.9% had Crohn's disease, whereas 38.6% had ulcerative colitis. Most patients (66.3%) were exposed to antibiotics during the study period. Antibiotic-exposed patients were more likely to have Crohn's disease (63% versus 53.7%; P 0.05), require narcotics (43.7% versus 14.9%; P < 0.0001), receive antidepressants (43.1% versus 18.6%; P < 0.001), prednisone (52.7% versus 31%; P < 0.0001), or biological therapy (52% versus 36.5%; P < 0.0001). Antibiotic-exposed patients had a lower mean Short IBD Questionnaire (50.2 ± 11.5 versus 56.4 ± 9.5; P < 0.0001), higher rates of C-reactive protein elevation (49.2% versus 31.8%; P < 0.0001), and higher health care utilization compared with nonantibiotic-exposed patients. Conclusions: The majority of patients with IBD receive antibiotic treatment, and these individuals demonstrate a more severe clinical course.

Original languageEnglish (US)
Pages (from-to)2576-2582
Number of pages7
JournalInflammatory Bowel Diseases
Volume21
Issue number11
DOIs
StatePublished - Jan 1 2015

Keywords

  • IBD
  • antibiotics
  • disease activity
  • quality of life

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

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