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David M. Spiro, MD; Donald H. Arnold, MD; Fabio Barbone, MD, DrPH

Arch Pediatr Adolesc Med. 2003;157:54-59.

Background  Intussusception is the leading cause of intestinal obstruction in young children. Antibiotics are the most frequently prescribed medication in the pediatric population and have common adverse effects on the gastrointestinal tract.

Objective  To determine whether a relationship exists between primary idiopathic intussusception and antibiotic drug use.

Design  Case-control study.

Participants  Ninety-three case patients with intussusception and 353 injury controls younger than 4 years who were seen at the emergency department of the Children's Hospital of Alabama between January 1, 1996, and April 30, 2001, were included. Controls were matched to cases by quarter and year of time of diagnosis, age, and sex.

Main Outcome Measures  Odds ratios and 2-sided 95% confidence intervals were estimated using conditional logistic regression. Prevalence of antibiotic use in an age-standardized, representative sample of US children from NHANES III (Third National Health and Nutrition Examination Survey) was used for external comparisons.

Results  Antibiotic use within 48 hours of diagnosis was found in 23 cases (25%) and 33 controls (9%) (odds ratio, 4.15; 95% confidence interval, 2.17-7.92; attributable risk, 18.7%). Antibiotic use among US children according to NHANES III was 10.7%. In cases, the -lactam class accounted for 78% of all medications used. Cephalosporin use was associated with more than a 20-fold increased risk of intussusception.

Conclusion  An association between antibiotic drug use and intussusception was identified.

From the Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Alabama (Drs Spiro and Arnold), Birmingham, and the Department of Epidemiology and International Health, School of Public Health (Dr Barbone), University of Alabama at Birmingham. Dr Arnold is currently with the Department of Emergency Medicine, Vanderbilt University, Nashville, Tenn. Dr Barbone is now with the Department of Hygiene and Epidemiology, DPMSC, Udine University, Udine, Italy.

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