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Antibiotics Are Associated with Intussusception

Cephalosporin use was associated with the highest increase in risk.

Intussusception is the most common cause of intestinal obstruction in young children; promotility agents and other medications have been linked to its development. Investigators explored associations between intussusception and antibiotic use in this retrospective chart review of 93 patients younger than 4 years with intussusception and 353 age- and sex-matched controls who visited the emergency department for injuries.

Antibiotic use was strongly associated with intussusception; 25% of cases had received antibiotics in the 48 hours before diagnosis, compared with only 9% of controls (odds ratio, 4.15; attributable risk 18.7%). As in previous studies, there was an association between intussusception and use of gastrointestinal medications. No associations were found with other medications. ß-Lactams (penicillins and cephalosporins) were the most commonly used antibiotics and were most strongly associated with intussusception. Children who had used cephalosporins had a 20 times greater risk for intussusception than did children who had not recently used antibiotics (OR, 22.49). Antibiotic use contributed to the attributable risk for intussusception in 18.7% of the affected patients. The rate of antibiotic use among controls was similar to rates reported in national surveys, but the rate among patients with intussusception was 2.3 times higher than national rates.

Comment: Associations don't prove causation. This study is the first to link antibiotics, especially cephalosporins, with intussusception. The findings do not elucidate how antibiotics contribute to intussusception. However, information on recent cephalosporin use should now be part of the medical history in children with signs of intestinal obstruction. This study adds more evidence for our discussions with parents about limiting inappropriate antibiotic use.

— F. Bruder Stapleton, MD

Published in Journal Watch Pediatrics and Adolescent Medicine January 27, 2003

Citation(s):

Spiro DM et al. Association between antibiotic use and primary idiopathic intussusception. Arch Pediatr Adolesc Med 2003 Jan; 157:54-9.

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