Table 4.
Association between antibiotic class and measures of child body mass
| Study group | Summary measure and outcome | Antibiotic class | Association estimate (95% CI) | |||
|---|---|---|---|---|---|---|
| Studies stratifying by exposure window (months) | ||||||
| <6 months | 6–11 months | 12–17 months | 18–23 months | |||
| Saari et al. [33] | aOR for overweight at ⩾24 months | Penicillins – boys | 1.28 (0.99–1.62) | 1.29 (1.04–1.49)* | 1.28 (0.95–1.42) | 0.95 (0.78–1.28) |
| Cephalosporins – boys | 1.44 (0.97–2.35) | 1.44 (1.04–1.84)* | 1.46 (1.06–1.82)* | 1.10 (0.78–1.43) | ||
| Macrolides – boys | 1.65 (1.09–2.31)* | 1.41 (1.09–1.70)* | 1.10 (0.84–1.34) | 1.42 (1.18–1.93)* | ||
| Penicillins – girls | 1.20 (0.87–1.66) | 1.20 (0.97–1.50) | 1.04 (0.81–1.33) | 1.15 (0.87–1.52) | ||
| Cephalosporins – girls | 1.25 (0.67–2.35) | 1.18 (0.79–1.76) | 1.27 (0.88–1.82) | 1.11 (0.75–1.64) | ||
| Macrolides – girls | 1.53 (0.90–2.60) | 1.11 (0.82–1.50) | 1.28 (0.95–1.71) | 1.21 (0.88–1.65) | ||
| <6 months | 6–11 months | 12–17 months | 18–23 months | |||
| Baileya et al. [30] | Adjusted hazard ratio for obesity at 24–59 months | Broad spectrumb
Narrow spectrumb |
1.12 (1.03–1.19)* 1.03 (0.6–1.08) |
1.1 (1.05–1.15)* 0.8 (0.3–1.04) |
1.06 (0.99–1.12) 1.01 (0.6–1.06) |
1.05 (0.7–1.15) 1.02 (0.4–1.11) |
| <6 months | <24 months | |||||
| Gerber et al. [29] | Adjusted difference in rate of weight gain (%) between 2 and 5 years | Broad spectrum (nonmacrolide) Broad spectrum (macrolide) Narrow spectrum |
−0.3 (−2.1 to 1.5) 2.2 (−1.2 to 5.7) 0.4 (−0.6 to 1.3) |
2.2 (0.7–3.8)* 2.4 (0.6–4.2)* 1.9 (0.5–3.2)* |
||
| ⩽12 months | ||||||
| Li et al. [32] | aOR for obesity at 2–18 years | Broad spectrum Narrow spectrum |
1.02 (0.99–1.05) 1.01 (0.97–1.04) |
|||
| Studies stratifying by number of antibiotic courses | ||||||
| 1–2 courses | 3–5 courses | 5+ courses | ||||
| Scott et al. [21] | aOR for obesity at 4 years | Anaerobic coveragec
No anaerobic coveragec |
1.09 (0.95–1.25) 1.09 (0.93–1.27) |
1.45 (0.91–1.68) 1.24 (0.91–1.68) |
1.46 (1.09–1.96)* 1.00 (0.63–1.60) |
|
| 1 course | 2+ courses | |||||
| Mbakwa et al. [31] | Adjusted difference (β) in zBMI at ⩽10 years aOR for overweight at ⩽10 years |
Broad spectrum β-lactams Narrow spectrum β-lactams Macrolide Antimetabolite Others Broad spectrum β-lactams Narrow spectrum β-lactams Macrolide Antimetabolite Others |
−0.05 (−0.16 to 0.06) 0.08 (−0.10 to 0.26) 0.09 (−0.05 to 0.23) −0.05 (−0.30 to 0.19) 0.13 (−0.29 to 0.56) 0.95 (0.68–1.34) 1.00 (0.57–1.76) 1.29 (0.89–1.86) 0.83 (0.33–2.11) 1.62 (0.52–5.06) |
0.07 (−0.04 to 0.19) 0.16 (−0.18 to 0.49) −0.07 (−0.28 to 0.14) −0.02 (−0.41 to 0.37) −0.16 (−0.51 to 0.19) 1.20 (0.86–1.67) 0.41 (0.06–2.63) 0.64 (0.35–1.16) 0.67 (0.19–2.31) 0.50 (0.21–1.20) |
||
| 1 or 1+ courses | 2+ courses | |||||
| Rogawski et al. [28] | Adjusted difference (β) in WAZ at 6 months to 2 years | Metronidazole Macrolides Cephalosporins Penicillins Fluoroquinolones Sulphonamides |
0.14 (−0.01 to 0.29) 0.09 (−0.03 to 0.21) 0.03 (−0.09 to 0.16) 0.09 (−0.02 to 0.19) 0.08 (−0.14 to 0.30) 0.03 (−0.09 to 0.15) |
0.24 (0.04–0.43)* 0.23 (0.05–0.42)* 0.19 (0.04–0.35)* 0.07 (−0.04 to 0.18) |
||
zBMI, body mass index-for-age z-score; WAZ, weight-for-age z-score; aOR, adjusted odds ratio.
Measures of association are relative to the unexposed group, and are presented with 95% CIs unless stated otherwise.
*p < 0.05.
See online Supplementary Table S3 for adjustments relating to analyses in each study.
a
Estimates read off graph.
b
Penicillin and amoxicillin classified as narrow spectrum operationally, all other agents considered broad.
c
Antibiotics with anaerobic coverage: penicillins, imidazoles, lincosamides, tetracyclines; without anaerobic coverage: cephalosporins, macrolides, sulpha-containing agents, isoniazid, rifampicin, fluoroquinolones, aminoglycosides.