婴儿口服抗生素时,或应避免补铁

创作:hx 审核:沈志勋 11月30日
将28名8–10月婴儿随机分为4组,进行40天含铁营养素(Fe)和/或5天抗生素(Ab)干预;
Fe+Ab+组婴儿的双歧杆菌相对丰度下降,艰难梭菌相对丰度上升,而Fe-Ab+组未见此改变;
Fe-Ab+组婴儿的致病性大肠杆菌相对丰度和肠道PH下降,但Fe+Ab+组中未见减少;
Fe+Ab+组婴儿腹泻的发病率高于Fe-Ab+组和Fe+Ab-组;
铁元素补充可以改变抗生素对肠道菌群的影响,减少抗生素对潜在肠致病菌(特别是致病大肠杆菌)的效力,同时可能增加腹泻的风险。
延伸阅读
Gut [IF:17.016]

Iron-containing micronutrient powders modify the effect of oral antibiotics on the infant gut microbiome and increase post-antibiotic diarrhoea risk: a controlled study in Kenya

含铁微量营养素可改变口服抗生素对肯尼亚婴儿肠道菌群的影响并增加腹泻的风险:一项随机对照研究

11-17, Article, 10.1136/gutjnl-2018-317399more

Abstract:
Objective : Many African infants receiving iron fortificants also receive antibiotics. Antibiotic efficacy against enteropathogens may be modified by high colonic iron concentrations. In this study, we evaluated the effect of antibiotics on the infant gut microbiome and diarrhoea when given with or without iron-containing micronutrient powders (MNPs).
Design : In a controlled intervention trial, four groups of community-dwelling infants (n=28; aged 8–10 months) received either: (A) antibiotics for 5 days and iron-MNPs for 40 days (Fe+Ab+); (B) antibiotics and no-iron-MNPs (Fe−Ab+); (C) no antibiotics and iron-MNPs (Fe+Ab−); or (D) no antibiotics and no-iron-MNPs (Fe−Ab−). We collected a faecal sample before the first antibiotic dose (D0) and after 5, 10, 20 and 40 days (D5–D40) to assess the gut microbiome composition by 16S profiling, enteropathogens by quantitative PCR, faecal calprotectin and pH and assessed morbidity over the 40-day study period.
Results : In Fe+Ab+, there was a decrease in Bifidobacterium abundances (p<0.05), but no decrease in Fe−Ab+. In Fe−Ab+, there was a decrease in abundances of pathogenic Escherichia coli (p<0.05), but no decrease in Fe+Ab+. In Fe−Ab+, there was a decrease in pH (p<0.05), but no decrease in Fe+Ab+. Longitudinal prevalence of diarrhoea was higher in Fe+Ab+ (19.6%) compared with Fe−Ab+ (12.4%) (p=0.04) and compared with Fe+Ab− (5.2%) (p=0.00).
Conclusion : Our findings need confirmation in a larger study but suggest that, in African infants, iron fortification modifies the response to broad-spectrum antibiotics: iron may reduce their efficacy against potential enteropathogens, particularly pathogenic E. coli, and may increase risk for diarrhoea.

First Authors:
Daniela Paganini

Correspondence Authors:
Michael B Zimmermann

All Authors:
Daniela Paganini,Mary A Uyoga,Guus A M Kortman,Colin I Cercamondi,Hans C Winkler,Jos Boekhorst,Diego Moretti,Christophe Lacroix,Simon Karanja,Michael B Zimmermann