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Use of antibiotics targeting gastrointestinal infections was associated with a greater risk for older-onset inflammatory bowel disease (IBD), a risk that was dose-dependant and persisted for years after an exposure, a population-based study from Denmark found.

In the analysis of over 2 million adults ages 60 and over, use of any antibiotic was associated with a 64% higher risk for developing IBD (incidence rate ratio [IRR] 1.64, 95% CI 1.58-1.71), reported Adam Faye, MD, of the NYU Grossman School of Medicine in New York City.

The highest risk was seen in the 1 to 2 years following an antibiotic prescription (IRR 1.87, 95% CI 1.79-1.94), but the risk persisted at 2 to 5 years as well (IRR 1.42, 95% CI 1.36-1.48), according to his presentation at a press briefing ahead of the Digestive Disease Week meeting, held virtually and in San Diego this year.

"Inflammatory bowel disease often can be overlooked in older adults because there's a lot of different diagnoses you're thinking of," said Faye. "It should be considered, especially if you have a patient who's reporting that they had multiple courses of antibiotics within the past few years."

IBD risk increased from 27% after a single course of antibiotics in the past 5 years (IRR 1.27, 95% CI 1.21-1.33) to 135% with five or more courses (IRR 2.35, 95% CI 2.24-2.47), the study found.

Older patients are the fastest growing subpopulation of IBD, accounting for 15% of new cases, Faye said during his presentation, but this subset is less likely to have a family history of either ulcerative colitis or Crohn's disease, raising the possibility of other factors playing a greater role.

In the study, the association was restricted to antibiotics that target pathogens in the gastrointestinal tract, with the greatest risk seen with fluoroquinolones (IRR 2.27, 95% CI 2.08-2.48), nitroimidazoles (IRR 2.21, 95% CI 1.95-2.50), and macrolides (IRR 1.74, 95% CI 1.64-1.84).

"This stresses in our clinical practice the need to be judicious in the use of antibiotics, including [to] limit inappropriate use and overprescribing," said Sandra El-Hachem, MD, of the Allegheny Center for Digestive Health in Pittsburgh, who was not involved in this study.

"Antibiotic stewardship is important, but avoiding antibiotics at all costs is not the right answer either," Faye said. "If you're not sure what you are treating, I would be cautious. If patients are coming in with clear infections and they need antibiotics, they should not be withheld because of these findings."

For their study, the researchers examined nationwide registry data from Denmark on 2,327,796 adults 60 and over from 2000 to 2018, representing over 22 million years of follow-up. During that time, 10,773 new cases of ulcerative colitis and 3,825 new cases of Crohn's disease were diagnosed, with ICD-10 codes used to confirm diagnoses. Antibiotic prescriptions that occurred less than 1 year before an IBD diagnosis were excluded.

All results remained significant after stratifying patients by disease type, with point estimates slightly higher for Crohn's disease.

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