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American Journal of Epidemiology Advance Access published online on April 5, 2006
American Journal of Epidemiology, doi:10.1093/aje/kwj123
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.
Received October 17, 2005
Accepted December 21, 2005

ORIGINAL CONTRIBUTIONS

Antibiotic Use and Risk of Multiple Sclerosis

Alvaro Alonso 1 *, Susan S. Jick 2, Hershel Jick 2, and Miguel A. Hernán 1

1 Department of Epidemiology, Harvard School of Public Health, Boston, MA
2 Boston Collaborative Drug Surveillance Program, Boston University, Lexington, MA

* To whom correspondence should be addressed.
Alvaro Alonso, E-mail: aalogut{at}alumni.unav.es


  Abstract

Some reports suggest that bacteria, including Chlamydophila pneumoniae, could be involved in the etiology of multiple sclerosis. If that is true, persons who used antibiotics active against these bacteria, compared with nonusers, might be at lower risk of multiple sclerosis. Using a 1993-2000 case-control study nested in the United Kingdom-based General Practice Research Database cohort, the authors identified 163 multiple sclerosis cases who were followed up for at least 3 years before their first symptoms (the index date). Up to 10 controls matched to the cases by age, sex, general practice, and time in the cohort were selected. Exposure to antibiotics was assessed through computerized medical records. Overall antibiotic use or use of antibiotics against C. pneumoniae was not associated with multiple sclerosis risk. However, use of penicillins in the 3 years before the index date decreased the risk of developing a first attack of multiple sclerosis (odds ratio = 0.5, 95% confidence interval: 0.3, 0.9 for those who used penicillins for ≥15 days compared with no use). In conclusion, use of antibiotics active against C. pneumoniae was not associated with a decreased risk of short-term multiple sclerosis. The observed lower risk of multiple sclerosis for penicillin users needs to be confirmed in other populations.

Keywords: anti-bacterial agents; Chlamydophila pneumoniae; multiple sclerosis; prospective studies.
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