Antibiotics may trigger IBD in older adults, study shows

The greatest achievement in medicine of the 20th century was the development of antibiotics. The German physician, Paul Ehrlich, in 1909, developed the first antibiotic, Salvarsan, used for the treatment of syphilis. The number of limbs and lives saved using antibiotics surpass counting. As we learn, however, we identify a growing number of adverse consequences to the use of antibiotics. A new study by doctors at the New York University Grossman School of Medicine reveals that the more antibiotics prescribed to patients 60 and older, the more likely they were to develop inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis.

The finding, from a review of 2.3 million patient records, suggests that antibiotic use contributes to the increase in the occurrence of IBD in older people. 

“In older adults, we think that environmental factors are more important than genetics,” explains Dr. Adam S. Faye, lead researcher and assistant professor of medicine and population health, in a statement. “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.”

Researchers reviewed prescribing records for people aged 60 and older who were newly diagnosed with inflammatory bowel disease from 2000 to 2018. The study found that any antibiotic use was associated with higher rates of IBD. The risk in an individual increased significantly with each course. 

After one prescription, patients were 27 percent more likely than those with no antibiotic use to be diagnosed with IBD. With two courses, the risk rose by 55 percent; with three courses it rose by 67 percent. With four courses, risk rose by 96 percent. With five or more courses, seniors were more than 2.3 times (risk increased 236 percent), more likely to receive a new IBD diagnosis than those with no antibiotics in the previous five years. New diagnoses were most common within one to two years of antibiotic treatment

The relationship was found for all types of antibiotics except nitrofurantoin, which is prescribed for urinary tract infections. Antibiotics usually prescribed for gastrointestinal (GI) infections were the most likely to be associated with a new IBD diagnosis. 

The study suggests that in older adults with new GI symptoms, the diagnosis of IBD should be considered, especially when there’s a history of antibiotic prescriptions, Dr. Faye states.

“Antibiotic stewardship is important, but avoiding antibiotics at all costs is not the right answer either,” Dr. Faye said. “If patients are coming in with clear [certain] infections, and they need antibiotics, they should not be withheld because of these findings.”

The study was conducted in partnership with the Danish National Center of Excellence PREDICT Program. 

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