European Journal of Epidemiology

, Volume 31, Issue 1, pp 85–94 | Cite as

Antibiotic exposure in the first year of life and later treated asthma, a population based birth cohort study of 143,000 children

  • Gisella Pitter
  • Jonas Filip Ludvigsson
  • Pierantonio Romor
  • Loris Zanier
  • Renzo Zanotti
  • Lorenzo Simonato
  • Cristina CanovaEmail author


Several epidemiological studies reported an association between antibiotic consumption in the first year of life and later asthma, but results are conflicting and affected by potential biases. We examined this controversial issue in a population-based birth cohort. Using administrative data, we identified 143,163 children born in 1995–2011 in Friuli-Venezia Giulia (Italy) (median follow-up 5.25 years, 927,350 person-years). Antibiotic prescriptions in the first year of life and subsequent treated asthma (defined as ≥2 anti-asthmatic drug prescriptions within a 12-month period) were retrieved from drug prescription records. We estimated incidence rate ratios (IRR) using Poisson regression models, adjusted for perinatal variables and for hospitalizations for infections in the first year of life. We identified 34,957 new-onset asthma cases. Antibiotic consumption in the first year of life increased the risk of new-onset asthma [IRR 1.51, 95 % confidence interval (CI) 1.48–1.54] with a dose–response relationship (p-trend <0.001). The risk was highest for asthma identified at 13–35 months of life (IRR 2.07, 95 % CI 2.00–2.14), but remained statistically significant for asthma identified at 36–71 months (IRR 1.17, 95 % CI 1.14–1.21) and at ≥72 months (IRR 1.15, 95 % CI 1.08–1.22). Antibiotics increased the risk of current asthma at ≥6 years (IRR 1.35, 95 % CI 1.30–1.41) and at ≥13 years of age (IRR 1.19, 95 % CI 1.08–1.33). Antibiotic exposure in infancy is associated with an increased risk of asthma up to adolescence. The association detected at older ages is not explained by reverse causation; however, confounding by respiratory infections not leading to hospital admission cannot be excluded.


Antibiotics Asthma Birth cohort Childhood asthma Record-linkage study 



All phases of this study were supported by a grant from the University of Padua to Dr. Cristina Canova (Senior Grant Holder, year 2013, F.S.

Ethical standards

The manuscript does not contain clinical studies or identifiable patient data.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10654_2015_38_MOESM1_ESM.doc (40 kb)
Supplementary material 1 (DOC 39 kb)


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Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Gisella Pitter
    • 1
  • Jonas Filip Ludvigsson
    • 2
    • 3
  • Pierantonio Romor
    • 4
  • Loris Zanier
    • 5
  • Renzo Zanotti
    • 1
  • Lorenzo Simonato
    • 1
  • Cristina Canova
    • 1
    Email author
  1. 1.Laboratory of Public Health and Population Studies, Department of Molecular MedicineUniversity of PaduaPaduaItaly
  2. 2.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
  3. 3.Department of PediatricsÖrebro University HospitalÖrebroSweden
  4. 4.Friuli-Venezia Giulia Regional Health Information SystemInformatica per il Sistema degli Enti Locali (INSIEL) S.p.A.UdineItaly
  5. 5.Epidemiological Service, Health DirectorateFriuli Venezia-Giulia RegionUdineItaly

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