Association Between Adult Antibiotic Use, Microbial Dysbiosis and Atopic Conditions – A Systematic Review

Abstract

Background

Strong associations between early antibiotic exposure and increased risk of childhood allergies have been established. Antibiotics have the potential to induce microbial dysbiosis that may be linked to allergic conditions. This review examines the limited available evidence on the associations between adult antibiotic use, microbial dysbiosis and atopic conditions.

Methods

A systematic literature search was conducted using PubMed and Embase for relevant studies, published between 01–01–2000 and 08–17–2022. We searched for associations between antibiotic use, microbial dysbiosis, and allergic conditions in adults, defined as over 13 years of age for the purposes of this review.

Results

Twenty-one studies were analyzed, with the inclusion of four narrative reviews as scarce relevant literature was found when stricter selection criteria were employed. Relevant studies predominantly focused on asthma. Significant microbial differences were observed in most measures between healthy subjects and subjects with allergic conditions. However, no system-wise and strain-wise associations were evident. Notably, at the phyla level, the Bacillota and Pseudomonadota phyla were associated with asthmatics, while the Actinobacteria phylum was linked to healthy controls. Asthmatics tends to reflect upregulation in the Bacillota and Pseudomonadota phyla in both airway and gut microbiomes.

Conclusion

No compelling evidence could be found between adult antibiotic exposure, consequent microbial dysbiosis, and allergic conditions in adults. Our review is limited by scarce literature and therefore remains inconclusive. However, potential implications of antibiotic use impacting on allergic conditions justify additional research and heightened pharmacovigilance in this area.

Keywords:

• atopy
• allergic
• asthma
• microbiome

Abbreviations

AMR, antimicrobial resistance; AAP, appropriate antibiotic prescribing, SLR, systematic literature review; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; GRACE, Good Research for Comparative Effectiveness; SCFA, short-chain fatty acids; T2, Type 2 Inflammation; PPAR, Peroxisome proliferator-activated receptor; ICS, inhaled corticosteroids.

Author Contributions

All listed authors for this SLR meet the authorship criteria as outlined by International Committee of Medical Journal Editors (ICMJE), bear accountability for the integrity of their written article, and have agreed to have this article published in this journal.

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Wan Zhen Janice Ng has no disclosures. Bhumika Aggarwal, James van Hasselt and Anand Manoharan are employees of GSK and hold stocks or shares in the company.

Additional information

Funding

This research was funded by GSK.