Antibiotic use among children linked to high obesity rate

Antibiotic prescriptions for children with simple colds, viral infections, minor ailments, and to healthy individuals without a fever on a “just in case” basis are “routine and the modus operandi of many practitioners”.

And this may be one of the main contributors to Malta’s high obesity rate according to leading paediatrician Simon Attard Montalto.

In a hard-hitting editorial on the Malta Medical Journal, Attard Montalto refers to studies linking the liberal administration of antibiotics to childhood obesity and calls for a more judicious use of the lifesaving but potentially harmful drugs.

The abuse of antibiotics is mostly linked to the increased risk of antibiotic-resistance and the potential emergence of superbugs but exposure to antibiotics also increases the risk of those children becoming overweight or obese.

But the latter risk is still under-appreciated locally, even if it has been proven in a local study conducted by Dr Marwa Khaled Grada in 2020 among children aged between three and seven years of age. In the study Dr Grada showed “a significant association between antibiotic use and increased childhood Body Mass Index.  Moreover, in this study, the use of antibiotics during infancy was found to be the best predictor of increased BMI.

The consumption of antibiotics during childhood result in an alteration in gut microbiota and the subsequent alteration of the digestive mechanisms of the bowel resulting in an increase in the absorption of short-chain fatty acids.

“In effect, children whose bowel microflora is repeatedly ‘altered’ by antibiotic exposure, are significantly more likely to change their bowel function to one that is obesogenic”.

According to Attard Montalto Malta, like other Mediterranean countries has a penchant for antibiotic over-use, “mostly in the context of viral infections” and are often used spuriously as a ‘prophylaxis’ (drugs aimed at preventing a disease) without any evidence-base.

The leading paediatrician denounces that in Malta, antibiotic prescriptions for children with simple colds/snuffles, viral infections, minor ailments, and to healthy individuals without a fever and “just in case” are “routine and the modus operandi of many practitioners”.

He concludes that a reduction in the injudicious use of antibiotics to small children will help reduce obesity later in life, which he describes “the greatest nutritional and one of the greatest health care problems in the ‘modern’ era”.

According to a Eurobarometer survey published in November 2022 Malta registers the highest proportion of respondents in the EU, who reported taking antibiotics in the previous 12 months. The proportion of respondents who took antibiotics was the highest in Malta (42%) and the lowest in Sweden and Germany (both 15%), Poland (16%) and the Netherlands and Denmark (both 18%).

But in an indication that health information campaigns on anti-microbial resistance are making some headway, the survey shows a 15-percentage point (pp) increase in the proportion of Maltese who correctly replied that antibiotics are ineffective against colds, and an 18-pp increase in the proportion who believe antibiotics are ineffective against a virus.