Antibiotic Use, Inflammatory Bowel Disease Related in Older Adults

Any antibiotic use was associated with higher rates of IBD, and the risk went up substantially with each course.

A recent study found that the more antibiotics prescribed to patients 60 years of age and older, the more likely they were to develop inflammatory bowel disease (IBD). The findings indicate that antibiotic use may be associated with the growth in Crohn disease and ulcerative colitis cases in older people, according to a presentation at Digestive Disease Week 2022.

“In older adults, we think that environmental factors are more important than genetics,” said lead study researcher Adam S. Faye, MD, MS, assistant professor of medicine and population health at NYU Grossman School of Medicine, in a press release. “When you look at younger patients with new diagnoses of Crohn's disease and ulcerative colitis, there's generally a strong family history. But that is not the case in older adults, so it's really something in the environment that is triggering it.”

The research team used Denmark’s national database, which includes nearly all medical records for residents, and analyzed prescribing records for people 60 years of age and older who were newly diagnosed with IBD from 2000 to 2018. The study looked at the number of courses of antibiotics prescribed, how recently they had been prescribed in relation to the diagnosis, and specific classes of antibiotics used.

The study discovered that any antibiotic use was associated with higher rates of IBD, and the risk went up substantially with each course. Patients who use antibiotics were 27% more likely than those with no antibiotic use to be diagnosed with IBD after 1 prescription. With 2 courses, the risk rose by 55% and with 3 courses it rose by 67%.

The risk rose by 96% with 4 courses, according to the study. With 5 or more courses, senior citizens were more than 2.3 times (236%) more likely to receive a new IBD diagnosis than those with no antibiotics in the previous 5 years.

The new diagnoses were highest when antibiotics were prescribed 1 to 2 years before, but the risk remained elevated for prescriptions in the period 2 to 5 years before diagnosis. This relationship was found for all types of antibiotics, except nitrofurantoin, which is commonly prescribed for urinary tract infections.

The researchers did not include prescriptions less than a year before diagnosis to reduce the chance that prescriptions had been for symptoms of a yet-undiagnosed gastrointestinal disease.

The research has implications for diagnosing older adults with new gastroenterological symptoms, in addition to developments for antibiotic stewardship.

“Antibiotic stewardship is important; but avoiding antibiotics at all costs is not the right answer either,” Faye said in the press release. “If you’re not sure what you are treating, I would be cautious. If patients are coming in with clear infections, and they need antibiotics, they should not be withheld because of these findings.”

REFERENCE

Antibiotic use associated with inflammatory bowel disease in older adults. EurekAlert! May 13, 2022. Accessed May 17, 2022. https://www.eurekalert.org/news-releases/952254