Association of Early Life Prescriptions for Antibiotics and Acid Suppressants with Childhood Psychotropic Prescriptions

Abstract

To examine the association between antibiotic and acid suppressant prescriptions in the first 2years of life and subsequent treatment for childhood psychiatric disorders. This was a retrospective cohort study of children born between October 2001 and September 2012 in the Military Health System enrolled in TRICARE past age 2years and within 35days of birth, with an initial hospital stay <7days, and without psychotropic agents dispensed during the first 2years of life. Exposure was defined as a filled prescription for an antibiotic or acid suppressant before age 2years, and the outcome was defined as a filled prescription for a psychotropic agent after age 2years. For the 804 920 patients (51% males and 49% female) composing the study population, the mean age at first psychotropic prescription was 6.8years. A total of 24 176 children (3%) were prescribed a proton pump inhibitor (PPI), 79 243 (10%) were prescribed a histamine-2 receptor antagonist (H2RA), and 607 348 (76%) were prescribed an antibiotic during the first 2years of life. The adjusted hazard ratio (aHR) of a psychotropic prescription was significantly increased in children prescribed any H2RA (1.79; 95% CI, 1.63-1.96), PPI (1.47; 95% CI, 1.26-1.71), or antibiotic (1.71; 95% CI, 1.59-1.84). The aHR of psychotropic prescriptions increased commensurately with each additional antibiotic class added and with each additional class of medication (H2RA, PPI, or antibiotics) prescribed. Children prescribed antibiotic and acid suppressants in the first 2years of life have a significant increase in future prescriptions for psychotropics, with a dose-related effect observed. This association represents a potential risk of early exposure to antibiotics and acid suppressants.