Paracetamol and antibiotics in childhood and subsequent development of wheezing/asthma: association or causation?
Open Access
- 22 January 2011
- journal article
- research article
- Published by Oxford University Press (OUP) in International Journal of Epidemiology
- Vol. 40 (3), 662-667
- https://doi.org/10.1093/ije/dyq263
Abstract
Background Several studies found an association between early administration of paracetamol and antibiotics and development of wheezing. This could be due to confounding: wheeze and asthmatic symptoms in early childhood are difficult to distinguish from respiratory tract infections that are widely treated with these drugs; in case of persistence of symptoms up to school age, this could explain the observed relationship. Methods We investigated the association between paracetamol and antibiotics use in the first year of life and wheezing phenotypes, i.e. wheezing starting in different time periods (early, persistent and late-onset) in the SIDRIA-2 study, a cross-sectional survey of 16 933 children aged 6–7 years. Directed acyclic graph (DAG) was used to depict the causal structure. Results Paracetamol and antibiotics administration in the first year were associated with early wheezing (first 2 years of life only) [odds ratio (OR): 2.27; 95% confidence interval (95% CI): 1.98–2.62 and OR = 3.76, 95% CI: 3.31–4.27] and with persistent wheezing (first 2 years + last 12 months) (OR = 1.77, 95% CI: 1.49–2.10 and OR = 3.06, 95% CI: 2.60–3.60), whereas the association with late-onset wheezing (in the last 12 months only) was weak (OR = 1.12, 95% CI: 0.97–1.31 and OR = 1.18, 95% CI: 1.02–1.38 for paracetamol and antibiotics, respectively). DAG shows that even in the absence of a direct (causal) arrow from early drugs use to wheezing at school age, the two are associated due to confounding (through the ‘infection’ node). Conclusions It is important to take into account different phenotypes in order to disentangle the association of paracetamol and antibiotics with wheezing.Keywords
This publication has 24 references indexed in Scilit:
- Antibiotic use in infancy and symptoms of asthma, rhinoconjunctivitis, and eczema in children 6 and 7 years old: International Study of Asthma and Allergies in Childhood Phase IIIJournal of Allergy and Clinical Immunology, 2009
- Acetaminophen Use and the Risk of Asthma in Children and AdultsSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2009
- Association between paracetamol use in infancy and childhood, and risk of asthma, rhinoconjunctivitis, and eczema in children aged 6–7 years: analysis from Phase Three of the ISAAC programmeThe Lancet, 2008
- The association of early life exposure to antibiotics and the development of asthma, eczema and atopy in a birth cohort: confounding or causality?Clinical & Experimental Allergy, 2008
- Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approachEuropean Respiratory Journal, 2008
- A review of ibuprofen and acetaminophen use in febrile children and the occurrence of asthma-related symptomsClinical Therapeutics, 2007
- Increased Risk of Childhood Asthma From Antibiotic Use in Early LifeSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2007
- Does Antibiotic Exposure During Infancy Lead to Development of Asthma?Social psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2006
- Acetaminophen and the Risk of AsthmaSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2005
- Commentary: use of antibiotics and risk of asthma.International Journal of Epidemiology, 2004