A new study has provided further evidence of the relationship between certain oral antibiotics and the rise of kidney stones among children and adults.
From 12 classes of oral antibiotics, 5 have been associated with increased risk of suffering from nephrolithiasis. This is the result of a study published on the Journal of the American Society of Nephrology, in which the evidence points at the fact that suffering nephrolithiasis increases up to 2.33 times with the use of sulfas, 1.88 times with the use of cephalosporins, 1.70 times with the use of nitrofurantoin/methenamine, 1.67 times with the use of fluoroquinolones, and 1.27 times with the use of broad-spectrum penicillins.
The intake of any of these 5 specific classes of antibiotics within 3 to 12 months has been associated with greater risks of kidney stones. The study also revealed that children and adolescents seem to be especially susceptible. Other exploratory analyses also showed that antibiotic exposures at a younger age or within 3 to 6 months are closely related to nephrolithiasis. This relationship remained statistically significant for 3 to 5 years for all 5 antibiotic classes except for broad-spectrum penicillins.
These findings support the hypothesis that antibiotics are likely to contribute to the increasing prevalence and earlier age at onset of nephrolithiasis, according to Dr. Tasian and his collaborators. Further, the experts explained that since children receive more antibiotics than any other age group and 30% of antibiotics prescribed during ambulatory care visits are inappropriate, the risk is heightened, which is why it’s so necessary to reduce inappropriate outpatient antibiotic use.
As for a possible explanation for the association between antibiotic use and stone risk, antibiotic-induced changes in the gut microbiome might affect macronutrient metabolism and lead to kidney stones. However, the authors could not rule out direct antibiotic crystallization in the kidney. The short period between antibiotic use and nephrolithiasis also might be explained by temporary, antibiotic-induced changes in the urinary environment leading to stone formation in susceptible individuals. The investigators adjusted models for the rate of health care encounters, comorbidities, urinary tract infections, and use of medications including thiazide and loop diuretics, proton-pump inhibitors, and statins.
In the case-control study, the team matched 25,981 nephrolithiasis patients to 259,797 controls by age, sex, and date of diagnosis using electronic health records from the Health Improvement Network. This database included information from more than 13 million children and adults from 641 general practices in the United Kingdom during 1994 to 2015.
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