Oral antibiotic use and chronic disease: long-term health impact beyond antimicrobial resistance and Clostridioides difficile

Gut Microbes. 2020 Jul 3;11(4):1092-1103. doi: 10.1080/19490976.2019.1706425. Epub 2020 Feb 9.


We recently reported an increased colon cancer risk associated with oral antibiotic use in a large United Kingdom population. This association between antibiotic exposure and cancer risk adds to a growing body of evidence that antibiotic use has unintended off-target long-term health consequences. This addendum highlights major studies linking antibiotic use and chronic disease in pediatric and adult populations. Microbiota dysbiosis is the key proposed mechanism underlying antibiotic:disease associations, resulting in alterations in gene expression, epigenetic modification, colonization by pathogenic bacteria, instigation of biofilms, and immune regulation and inflammation. These adverse outcomes of antibiotic exposure underscore the need for diagnostic and antibiotic stewardship, as well as the urgency for further development of non-antibiotic therapies for bacterial infections.

Keywords: Colorectal cancer; antibiotic stewardship; antibiotics; cancer risk; carcinogenesis; microbiota dysbiosis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / adverse effects
  • Anti-Bacterial Agents / therapeutic use*
  • Antimicrobial Stewardship
  • Bacteria / drug effects
  • Bacterial Infections / drug therapy
  • Bacterial Infections / therapy
  • Child
  • Chronic Disease / epidemiology*
  • Clostridioides difficile
  • Clostridium Infections / etiology
  • Clostridium Infections / microbiology
  • Colonic Neoplasms / epidemiology
  • Drug Resistance, Bacterial
  • Drug Utilization*
  • Dysbiosis / etiology
  • Gastrointestinal Microbiome / drug effects*
  • Humans
  • Prescription Drug Overuse
  • Risk Factors


  • Anti-Bacterial Agents