Study: Do antibiotics reduce the vaccination effect in children?
Medicine : Study: do antibiotics reduce vaccine effectiveness in children?
Antibiotics could reduce children's immune response to vaccinations. Photo: julian stratenschulte/dpa/archive image
Rochester Antibiotics have helped countless sick children. Now there is evidence of another side effect of the drugs. However, it remains to be seen how significant this is.
If young children are prescribed antibiotics, various vaccines could work worse. That's what a U.S. study suggests, the results of which were published in the journal Pediatrics. As the medical experts suggest, an intestinal microbiome thrown out of balance by antibiotics could affect vaccination success – an argument that German experts say is conclusive. The interaction of microorganisms in the gut is important for digestion, among other things, but also for the immune system.
In fact, a 2019 study has already described that antibiotics can reduce the effectiveness of vaccinations in adults. Now, a team led by physicians Timothy Chapman and Michael Pichichero of the Rochester General Hospital Research Institute evaluated blood samples from 560 children over a period of 6 to 24 months of life. The samples had been taken as part of several screening tests, as well as when an acute middle ear infection occurred. 342 children from this cohort had received a total of nearly 1700 units of antibiotics in the first 24 months of life, while 218 children had received none.
Antibody level
The researchers then analyzed the children's antibody levels for the diphtheria, tetanus, polio, pertussis, influenza and pneumococcal vaccines. The result: antibody levels were lower on average in children treated with antibiotics than in those who did not receive antibiotics.
Among those children who received antibiotics between the ninth and twelfth months of life or repeatedly, these levels were particularly likely to be below the concentrations considered relevant for immune protection. "Thus, they would have an increased risk of contracting infections caused by the pathogens that were vaccinated against," explains Ulrich Schaible, director of the Infections Program Area at the Borstel Research Center, in an independent assessment.
Taking antibiotics for a shorter time
A more nuanced look at the results shows that, for example, the antibiotic amoxicillin alone had no effect, but in combination with clavulanic acid it did. Such combination preparations are prescribed due to their extended antibacterial spectrum of action. "It's also interesting that the combination of amoxicillin and clavulanate had a smaller effect on antibody production after five days than after giving it for ten days," Schaible notes, "So giving antibiotics for a shorter time seems to be better."
Meanwhile, the expert also stresses that the influence of the diseases for which the antibiotics were given on antibody formation after vaccination should be analyzed independently of antibiotic administration. This would mean studying children with similar diseases who did not receive antibiotics. Moreover, antibodies are only part of the immunological response to a vaccine, adds Claudius Meyer of the University Medical Center Mainz: "T-cell-mediated immune memory was not investigated in the study, but it is reasonable to ame that it was also induced and can thus mediate a protective effect."
Reduced immune protection
Furthermore, as the authors themselves write, they had not taken stool samples from the children. However, these are necessary to determine the effects of antibiotics on the intestinal microbiome.
"Antibiotics, which are often prescribed in early childhood for a middle ear infection, not only attack the dangerous bacteria in the ear, but also the beneficial bacteria of the gut microbiome," Cornelia Gottschick of the University of Halle-Wittenberg describes the underlying connection. "The balance of bacteria with our immune system is disrupted as a result, and it is conceivable that vaccines may not have their full effect as a result, leading to reduced immune protection."This connection remains theoretical in the current study, since the intestinal microbiome was not investigated.
It is possible that taking probiotics to protect the gut microbiome could reduce the effect observed in the study, Gottschick added. However, this would still have to be researched.