Antibiotic use in young children may lower vaccine-induced antibody levels

Children are often prescribed antibiotics during the first two years of life, a time in which they are also developing vaccine-induced immunity to several diseases. Studies in mice and limited studies in adults receiving seasonal influenza vaccine have suggested that antibiotic exposure reduces antibody responses to vaccination. It is uncertain whether antibiotic use affects the development of vaccine-induced immunity in young children. A new study in the journal, Pediatrics, examined this issue. The study included 560 children, six to 24 months of age. Vaccine antibody measurements were undertaken for diphtheria-tetanus-acellular pertussis (DTaP), inactivated polio, Haemophilus influenzae type b (Hib) and pneumococcal conjugate vaccines. Medical records were also analyzed for antibiotic prescriptions. Of the 560 children, 342 had received antibiotic prescriptions, and 218 had not. Results showed that vaccine-induced antibody levels to several DTaP and pneumococcal conjugate vaccines were lower in children given antibiotics (p < 0.05). At nine and 12 months of age, children who had received antibiotics had a higher frequency of vaccine-induced antibodies that were below protective levels (p < 0.05). Antibiotic courses over time were negatively associated with vaccine-induced antibody levels. For each antibiotic course a child received, pre-booster antibody levels to DTaP antigens were reduced by 5.8%, Hib by 6.8%, inactivated polio by 11.3% and pneumococcal conjugate vaccine by 10.4% (all p ≤ 0.05). Post-booster antibody levels to DTaP antigens were reduced by 18.1%, Hib by 21.3%, inactivated polio by 18.9% and pneumococcal conjugate vaccine by 12.2% (all p < 0.05). Read: Pediatric visits to the ED from cannabis exposure nine times higher after legalization Amoxicillin was not associated with antibody measurements below protective levels, while amoxicillin/clavulanate, ceftriaxone and cefdinir (not marketed in Canada) were. Amoxicillin/clavulanate was the only antibiotic with sufficient data to compare five- and 10-day courses. A 10-day course was negatively associated with protective antibody levels within 30 days of completion of the antibiotic course, but a five-day course was not. This is the first study to show an association between antibiotic use and a reduction in vaccine-induced antibody levels to several vaccines in children less than two years of age. These results provide clinicians with more evidence that antibiotics should be prescribed judiciously, with preference for narrow-spectrum agents and the shortest duration possible to avoid an adverse impact on vaccine-induced immunity. Reference 1. Chapman TJ, Pham M, Bajorski P, et al. Antibiotic use and vaccine antibody levels. Pediatrics 2022; published online April 27, 2022. (accessed May 3, 2022).

Antibiotic use in young children may lower vaccine-induced antibody levels

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