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Is antibiotics use really associated with increased risk of colorectal cancer? An updated systematic review and meta-analysis of observational studies

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Abstract

Purpose

The association between antibiotics and colorectal cancer (CRC) risk has drawn increasing attention but remains controversial. This study was performed to clarify the association.

Methods

A systematic review and meta-analysis was performed on seven electronic databases. The pooled odds ratios (OR) with a 95% confidence interval (CI) were calculated to estimate the association using the fixed-effects model or the random-effects model.

Results

Ten studies that contained 4,853,289 participants were included in our study. We found that antibiotics use was associated with a higher risk of CRC (OR 1.09, 95%CI 1.02–1.17, I2 = 92.8%). More than 60 days of antibiotics use and 5 prescriptions of antibiotics were significantly associated with a higher risk of CRC. Sub-analysis on different types of antibiotics found that anti-anaerobic antibiotics, penicillins, and quinolones use led to increased risk of CRC (OR 1.22, 95% CI 1.04–1.44, I2 = 89.1%; OR 1.09, 95% CI 1.04–1.13, I2 = 69.2%; OR 1.15, 95% CI 1.03–1.35, I2 = 88.2%; respectively) and colon cancer (OR 1.28, 95% CI 1.04–1.58, I2 = 98.5%; OR 1.09, 95% CI 1.05–1.12, I2 = 0; OR 1.09, 95% CI 1.04–1.15, I2 = 0; respectively). However, antibiotics use was not significantly associated with rectal cancer (OR 1.03, 95% CI 0.92–1.16, I2 = 77.6%).

Conclusion

It needs attention that antibiotics use is associated with a higher risk of CRC, especially for colon cancer. Clinicians should be aware of the potential risk of CRC when prescribing anti-anaerobic antibiotics, penicillins, and quinolones in the future. Further studies are needed to assess any potential differences by tumor sites and class of antibiotics.

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Author information

Authors and Affiliations

  1. Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China

    Guangbo Qu

  2. Internal Medicine, AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago, IL, 60657, USA

    Chenyu Sun, John Patrick Uy & Chandur Bhan

  3. Infectious Disease, AMITA Health Saint Joseph Hospital Chicago, 2900 N. Lake Shore Drive, Chicago, IL, 60657, USA

    Monica Sharma

  4. Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Evelyn J. Song

  5. Department of Child Health Care, Maternal and Child Health Care Hospital of Anhui Province (Affiliated Maternal and Child Health Care Hospital of Anhui Medical University), Hefei, 230001, Anhui, China

    Liqin Shu

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  1. Guangbo Qu
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Correspondence to Chenyu Sun.

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This systematic review and meta-analysis used previously published data and did not use any unpublished data. Therefore, ethical approval for analysis was not applicable.

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Qu, G., Sun, C., Sharma, M. et al. Is antibiotics use really associated with increased risk of colorectal cancer? An updated systematic review and meta-analysis of observational studies. Int J Colorectal Dis 35, 1397–1412 (2020). https://doi.org/10.1007/s00384-020-03658-z

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