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Antibiotics use and risk of amyotrophic lateral sclerosis in Sweden
Author(s) -
Sun J.,
Zhan Y.,
Mariosa D.,
Larsson H.,
Almqvist C.,
Ingre C.,
Zagai U.,
Pawitan Y.,
Fang F.
Publication year - 2019
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.13986
Subject(s) - medicine , antibiotics , medical prescription , amyotrophic lateral sclerosis , odds ratio , penicillin , population , respiratory tract infections , clostridium difficile , logistic regression , confidence interval , pediatrics , respiratory system , environmental health , disease , pharmacology , microbiology and biotechnology , biology
Background and purpose Previous animal studies have suggested a disrupted intestinal microbiome in amyotrophic lateral sclerosis ( ALS ). Due to the known effect of antibiotics on gut microflora, the potential role of antibiotics use on the risk of ALS deserves an investigation. Methods A nested case–control study was conducted using several Swedish national registers. In all, 2484 ALS patients diagnosed between 1 July 2006 and 31 December 2013 were included as cases, and five controls per case individually matched to the case by sex, birth year and area of residence were randomly selected from the general Swedish population. Information on antibiotics prescriptions before ALS diagnosis was extracted from the Prescribed Drug Register for both cases and controls. A conditional logistic regression model was used to calculate odds ratios ( OR s) and 95% confidence intervals ( CI s). Results After accounting for potential diagnostic delay in ALS by excluding all prescriptions within 1 year before diagnosis, any antibiotics use was associated with a higher risk of ALS . The OR s (95% CI s) were 1.06 (0.94–1.19), 1.13 (1.00–1.28) and 1.18 (1.03–1.35) when comparing 1, 2–3 and ≥4 prescriptions to no prescription ( P for trend = 0.0069). Similar results were noted for antibiotics used for respiratory infections and urinary tract as well as skin and soft tissue infections. Amongst different individual antibiotics, the risk of ALS was especially increased in relation to more than two prescriptions of beta‐lactamase sensitive penicillin ( OR 1.28; 95% CI 1.10–1.50). Conclusions Use of antibiotics, especially repeated, might be associated with a higher subsequent risk of ALS .