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 Researchers examined electronic health records collected from 1994
to 2015 for 25,981 people who developed kidney stones and a control
group of 259,797 similar individuals who did not. Using the kidney
stone diagnosis as an "index date," researchers then looked for
prior antibiotic prescriptions in both groups.
Exposure three to 12 months before the index date to any of five
antibiotics - sulfas, cephalosporins, fluoroquinolones,
nitrofurantoin/methenamine, and broad-spectrum penicillins - was
associated with an increased risk of kidney stones.
The risk increase associated with these antibiotics ranged from 27
percent higher odds with broad-spectrum penicillins to more than
doubled odds with sulfas.
"Without a doubt, antibiotics have saved millions of lives and are
needed to prevent death and serious harm from infections; the
benefits outweigh the potential harms," said lead study author Dr.
Gregory Tasian of the Children's Hospital of Philadelphia.
"These results don't suggest that antibiotics should not be
prescribed when indicated," Tasian said by email. "However, they do
support antibiotic stewardship - the judicious and appropriate use
of antibiotics and reducing inappropriate use of antibiotics for a
viral illness."
Scientists already knew that antibiotics alter the composition of
the human microbiome - all of the bacteria, viruses and fungi that
live in and on the body.
Changes in the intestinal and urinary microbiome have also been
linked to kidney stones, but no previous studies revealed an
association between antibiotics and stones, researchers note in the
Journal of the American Society of Nephrology.
The strongest risks for kidney stones were in children and
adolescents, the study found. The risk of kidney stones decreased
over time but remained elevated several years after antibiotic use.
Not all antibiotics were associated with an increased risk of kidney
stones, however. The study examined 12 types of antibiotics, and
found seven that didn't appear to influence the risk of kidney
stones.
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The study wasn't a controlled experiment designed to prove whether
or how antibiotics might cause kidney stones. Another limitation is
that some people might have had undiagnosed kidney issues before
they took antibiotics, potentially inflating the risk associated
with antibiotics.
Kidney stones can also take years to develop, and affect only about
10 percent of people, making it challenging to prove a direct link
to antibiotics that most people will take at some point in their
lives, said Jeremy Burton a researcher at the University of Western
Ontario and deputy director of the Canadian Centre for Human
Microbiome and Probiotics, Lawson Health Research Institute in
London, Ontario.
"Kidney stone disease rates have been increasing steadily for no
apparent reason, and many theories have been postulated. These range
from global warming resulting in decreased hydration, to the
microbiome changing due to an unhealthy Western diet," Burton, who
wasn't involved in the study, said by email.
"It is important to note that even with these enormous samples sizes
(in the study) some confounding factors may remain, such as
antibiotic use for the treatment of a urinary tract infection, a
condition associated with kidney stones," Burton added. "Nonetheless
these data suggest that there is a risk associated with certain
antibiotic use and kidney stones."
SOURCE: https://bit.ly/2K18NgN Journal of the American Society of
Nephrology, online May 10, 2018.
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