The link between early ear infections and inflammatory bowel disease

Add to the growing list of reasons antibiotics might not be good for you and your children: a recent study showing a statistical link between early ear infections and inflammatory bowel disease (IBD).

Researchers in the UK analyzed data from about a million children, looking specifically at the 750 who developed IBD (Crohn’s disease and ulcerative colitis, mostly.) They then compared the kids with IBD to children without that diagnosis, and looked back at the frequency of prior ear infections. Ear infections are the most common diagnosis leading to the use of antibiotics in young children, so it was figured that more ear infection diagnoses were a good marker for more antibiotics.

Their analysis found that early ear infections increased the risk of IBD substantially, probably by about 80%. The highest risk was among children with the most ear infections, and among children with the earliest diagnoses. So more antibiotics, and earlier antibiotics, seem to be predictive of the later development of IBD.

IBD is a complex illness. It seems to be related to altered immune regulation in the gut and other tissues. It’s been speculated that the normal bacteria in the gut help with the early formation and control of the immune system.  Early antibiotics could indeed interfere with that process, and are a plausible trigger for IBD, at least in people who are genetically predisposed. There are probably other factors at work, too.

Indiscriminate antibiotic use is bad news. It contributes to the development of resistant superbugs, and may play a role in the development of obesity, allergic disease, and asthma. Insidious forces can sometimes encourage the perceived “quick fix” of an antibiotic prescription—including rushed doctors, exasperated parents, and a health care system that rewards “satisfaction” over health. If you want to protect your child from unnecessary antibiotics, you have to ask a few questions:

  • Is this antibiotic really necessary?
  • Are there other options?
  • Is it safe to wait?
  • If we do need an antibiotic, what’s the safest one to use?

And, of course, remember that prevention is always better than cure. Keeping your child up to date on vaccines—including influenza vaccination—prevents both bacterial infections and some viral infections that predispose to ear infections and other antibiotic temptations. Nursing, avoiding group care, avoiding second-hand smoke, and not bottle-propping—all of these can help prevent at least some ear and other infections.

There will be times when an antibiotic is a good idea—I don’t want parents to be afraid of them when they really are necessary. But parents and doctors both need to take an active, thoughtful role in deciding when antibiotics are really a good idea.

Roy Benaroch is a pediatrician who blogs at The Pediatric Insider. He is also the author of Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide and A Guide to Getting the Best Health Care for Your Child.

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  • Jan Taco teGussinklo

    Perhaps there is a correlation. But is there really a causal relationship?? These type of speculations aren’t new.

  • Peter Elias

    “Add to the growing list of reasons antibiotics might not be good for you and your children: a recent study showing a statistical link between early ear infections and inflammatory bowel disease (IBD).”

    No. This is faulty logic and an unwarranted conclusion. The fact that there is a statistical association between frequent early OM and IBD is – in NO way – evidence that antibiotics are not good for you.

    The simplest explanation is that those children who get frequent OM starting early are different from those who do not, and that this difference (not the treatment for the OM or the OM itself) is what predisposes to IBD.

    There is a statistical association between July and sunburns. July does not cause sunburns.

    Correlation is not causation.


    Good advice–give antibiotics cautiously.

    Bad reasoning–antibiotics may not be the cause of IBD–maybe it has to do with a common cause of otitis media and IBD–much more likely. Cause and association are not the same. Most ear infections are associated with URIs. Maybe it’s the viruses that cause URIs that cause IBD? Or maybe it is the acid reflux that causes the ear infections in very young children that causes the IBD–part of the unified aerodigestive track theory (hmm where did that one go?)

    Speculation, pure speculation.

  • meyati

    How many children had ear aches and never had stomach trouble? Oh, a million minus 750—–

  • Roy Benaroch MD

    I agree this is a speculative conclusion. That’s why the title is bland, and the word “might” appears in the quote Peter used. The bulk of the text is an admonishment for a general audience against the overuse of antibiotics. That was supposed to be the “take away” message. Should have made that clearer.

    Thanks for comments, everyone.

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