What is the effect of antibiotic exposure on the microbiome in children, particularly in low-resource settings, regarding diversity, composition, and colonization resistance?

From the Guidelines

Antibiotic exposure has been shown to significantly disrupt the microbiome in children, particularly in low-resource settings, leading to reduced diversity, altered composition, and impaired colonization resistance. The effects of antibiotic exposure on the microbiome have been extensively studied, with a focus on children in low-resource settings 1. In these settings, antibiotics like gentamicin, ampicillin, and ceftriaxone are commonly used to treat neonatal and pediatric sepsis, but their use can lead to significant changes in the gut microbiome.

Some key points to consider include:

• The use of antibiotics in children can lead to a decrease in beneficial bacteria, such as Bifidobacterium and Lactobacillus, and an increase in potentially harmful organisms and antibiotic resistance genes 1.
• The impact of antibiotic exposure on the microbiome can vary based on factors such as antibiotic class, treatment duration, child's age, and baseline microbiome composition, with broader-spectrum antibiotics typically causing more extensive disruption 1.
• In low-resource settings, children face additional challenges, including malnutrition, poor sanitation, and higher infectious disease burden, which can exacerbate the effects of antibiotic exposure on the microbiome 1.
• The World Health Organization (WHO) recommends the use of gentamicin with either ampicillin or benzylpenicillin as first-line treatment for neonatal and pediatric sepsis in resource-limited settings, but recent studies have highlighted the increasing prevalence of resistance to these antibiotics, particularly in Gram-negative bacteria 1.

Overall, the use of antibiotics in children, particularly in low-resource settings, should be carefully considered and monitored to minimize the risk of disrupting the microbiome and promoting antibiotic resistance. This can be achieved through the development of evidence-based prescribing guidelines, antimicrobial stewardship programs, and education and training for healthcare professionals on rational prescribing practices 1.

From the Research

Effect of Antibiotic Exposure on the Microbiome

• The provided studies do not directly investigate the effect of antibiotic exposure on the microbiome in children, particularly in low-resource settings.
• However, studies such as 2 discuss the use of antibiotics in treating pneumonia in children in low-resource settings, which may have implications for the microbiome.

Diversity and Composition of the Microbiome

• There is no direct evidence in the provided studies on the impact of antibiotic exposure on the diversity and composition of the microbiome in children.
• Studies like 3 and 4 focus on the treatment of community-acquired pneumonia with antibiotics, but do not explore the effects on the microbiome.

Colonization Resistance

• The provided studies do not explicitly examine the effect of antibiotic exposure on colonization resistance in children.
• Research such as 5 highlights the importance of pediatric critical care in resource-limited settings, which may be relevant to understanding the broader context of antibiotic use and resistance.

Low-Resource Settings

• Studies like 2 and 5 are set in low-resource settings and discuss the challenges of treating pneumonia and providing critical care in these environments.
• Research such as 6 explores community-based interventions to optimize early childhood development in low-resource settings, which may have indirect implications for understanding the effects of antibiotic exposure on the microbiome.