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The case of drug causation of childhood asthma: antibiotics and paracetamol

AIM: The rising prevalence of bronchial asthma has led to world-wide efforts to understand and stem this development. Cross-sectional studies appear to show that early childhood use of antibiotics may be an important contributory factor, with paracetamol as an additional suspected cause. However, mo...

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Autores principales: Heintze, Konrad, Petersen, Karl-Uwe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3651816/
https://www.ncbi.nlm.nih.gov/pubmed/23292157
http://dx.doi.org/10.1007/s00228-012-1463-7
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author Heintze, Konrad
Petersen, Karl-Uwe
author_facet Heintze, Konrad
Petersen, Karl-Uwe
author_sort Heintze, Konrad
collection PubMed
description AIM: The rising prevalence of bronchial asthma has led to world-wide efforts to understand and stem this development. Cross-sectional studies appear to show that early childhood use of antibiotics may be an important contributory factor, with paracetamol as an additional suspected cause. However, mounting evidence, which is reviewed here, points to various confounding factors as the major reasons for these reported associations. METHODS: PubMed and EMBASE were systematically searched for studies on associations between antibiotics and/or paracetamol with asthma and/or wheezing, published up to November 2012. A total of 64 pertinent studies were identified, 35 focusing on antibiotics, 19 on paracetamol, and ten addressing both antibiotics and paracetamol, bringing the number of relevant datasets to 74. RESULTS: Numerous studies were cross-sectional and made no adjustment for the indication of antibiotics or paracetamol; consequently, they were unable to dismiss possible confounding by indication. Where such adjustments could be performed (mostly in longitudinal studies), they substantially weakened or entirely eliminated the association with asthma or asthma surrogates present in the unadjusted data. CONCLUSION: The weight of evidence of the collected studies in our review strongly suggests that the association of antibiotics with childhood asthma reflects various forms of bias, the most prominent of which is confounding by indication. Recent studies and meta-analyses support the same conclusion for paracetamol. Truly indicated antibiotics should not be withheld from infants or young children for fears they might develop asthma. Likewise, there is no sound reason to replace paracetamol as the preferred pain relief and fever medication in this age group. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00228-012-1463-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-36518162013-05-13 The case of drug causation of childhood asthma: antibiotics and paracetamol Heintze, Konrad Petersen, Karl-Uwe Eur J Clin Pharmacol Review Article AIM: The rising prevalence of bronchial asthma has led to world-wide efforts to understand and stem this development. Cross-sectional studies appear to show that early childhood use of antibiotics may be an important contributory factor, with paracetamol as an additional suspected cause. However, mounting evidence, which is reviewed here, points to various confounding factors as the major reasons for these reported associations. METHODS: PubMed and EMBASE were systematically searched for studies on associations between antibiotics and/or paracetamol with asthma and/or wheezing, published up to November 2012. A total of 64 pertinent studies were identified, 35 focusing on antibiotics, 19 on paracetamol, and ten addressing both antibiotics and paracetamol, bringing the number of relevant datasets to 74. RESULTS: Numerous studies were cross-sectional and made no adjustment for the indication of antibiotics or paracetamol; consequently, they were unable to dismiss possible confounding by indication. Where such adjustments could be performed (mostly in longitudinal studies), they substantially weakened or entirely eliminated the association with asthma or asthma surrogates present in the unadjusted data. CONCLUSION: The weight of evidence of the collected studies in our review strongly suggests that the association of antibiotics with childhood asthma reflects various forms of bias, the most prominent of which is confounding by indication. Recent studies and meta-analyses support the same conclusion for paracetamol. Truly indicated antibiotics should not be withheld from infants or young children for fears they might develop asthma. Likewise, there is no sound reason to replace paracetamol as the preferred pain relief and fever medication in this age group. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00228-012-1463-7) contains supplementary material, which is available to authorized users. Springer Berlin Heidelberg 2013-01-05 2013 /pmc/articles/PMC3651816/ /pubmed/23292157 http://dx.doi.org/10.1007/s00228-012-1463-7 Text en © The Author(s) 2012 https://creativecommons.org/licenses/by-nc/2.0/ Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
spellingShingle Review Article
Heintze, Konrad
Petersen, Karl-Uwe
The case of drug causation of childhood asthma: antibiotics and paracetamol
title The case of drug causation of childhood asthma: antibiotics and paracetamol
title_full The case of drug causation of childhood asthma: antibiotics and paracetamol
title_fullStr The case of drug causation of childhood asthma: antibiotics and paracetamol
title_full_unstemmed The case of drug causation of childhood asthma: antibiotics and paracetamol
title_short The case of drug causation of childhood asthma: antibiotics and paracetamol
title_sort case of drug causation of childhood asthma: antibiotics and paracetamol
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3651816/
https://www.ncbi.nlm.nih.gov/pubmed/23292157
http://dx.doi.org/10.1007/s00228-012-1463-7
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