Antibiotic Use in Childhood and Adolescence and Risk of Inflammatory Bowel Disease: A Case-Control Study in the UK Clinical Practice Research Datalink

Inflamm Bowel Dis. 2020 Feb 11;26(3):440-447. doi: 10.1093/ibd/izz137.


Background: Inflammatory bowel disease (IBD) causes serious morbidity and disability, and the incidence is increasing. The disease etiology is not well understood, though inflammatory reactions after antibiotic exposure may be associated with development of IBD. We investigated the association between IBD and prior antibiotic use.

Methods: We conducted this case-control study among individuals in the United Kingdom Clinical Practice Research Datalink GOLD (CPRD GOLD). Each case of IBD was matched to 4 controls on age, sex, general practice, and registration year in the CPRD GOLD. Antibiotic exposure was classified by ever or never use, number of prescriptions, and class of antibiotic before the index date. Odds ratios were calculated using conditional logistic regression.

Results: We identified 461 cases of ulcerative colitis (UC) and 683 cases of Crohn's disease (CD). There was no association between ever use of any antibiotic and UC (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.72-1.44) or CD (OR, 1.01; 95% CI, 0.73-1.39) compared with never use. A slightly increased CD risk was observed among ever users of quinolones (OR, 1.76; 95% CI, 1.00-3.11) and metronidazole (OR, 1.43; 95% CI, 0.87-2.34) compared with never users. CD was associated with antibiotic exposure before age 5 (OR, 2.20; 95% CI, 0.75-6.43) in an analysis restricted to individuals followed from birth.

Conclusions: There was no association between UC or CD and overall prior use of antibiotics, though prior use of metronidazole and quinolones was associated with a slightly increased risk of CD. Antibiotic use in early childhood may increase the risk of CD.

Keywords: Clinical Practice Research Datalink; Crohn’s disease; antibiotics; case–control study; inflammatory bowel disease; ulcerative colitis.

MeSH terms

  • Adolescent
  • Age Factors
  • Anti-Bacterial Agents / adverse effects*
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Colitis, Ulcerative / chemically induced
  • Crohn Disease / chemically induced*
  • Female
  • Humans
  • Logistic Models
  • Male
  • Metronidazole / adverse effects*
  • Quinolones / adverse effects*
  • Risk Factors
  • United Kingdom
  • Young Adult


  • Anti-Bacterial Agents
  • Quinolones
  • Metronidazole