SUMMARY:
The problem with antibiotics is not limited to increasing antibiotic resistance in bacteria. A group of scientists have found a link between the use of oral antibiotics and the risk of developing kidney stones. The findings will be published in the upcoming issue of the Journal of the American Society of Nephrology (JASN).

For unknown reasons, in the last 30 years the frequency of kidney stones (nephrolithiasis) has increased by 70% particularly among children and adolescents. That is why a team of scientists led by Gregory Tasian MD, MSc, MSCE and Michelle Denburg MD, MSCE (The Children’s Hospital of Philadelphia) researched to see if antibiotics were the cause.

The study involved examining electronic records of over 13 million adults and children who were given 12 classes of oral antibiotics from 1994 to 2015 by 641 general practices in the United Kingdom. They matched 25,981 patients suffering from nephrolithiasis to 259,797 controls by sex, age and practice at the index date (date of diagnosis).

If any patient was exposed to any of the selected antibiotics 3 to 12 months before the index date, then their nephrolithiasis was linked to those antibiotics.

The scientists found:

• Risks were increased 2.3 times for sulfas, 1.9 times for cephalosporins, 1.7 times for fluoroquinolones, 1.7 times for nitrofurantoin/methenamine, and 1.3 times for broad spectrum penicillins.

• The risk of nephrolithiasis declined over time but it remained high 3 to 5 years after taking the antibiotic.

• The risk was highest among young people.

Previous research had found that children receive the highest level of antibiotics of all age groups and that 30% of the antibiotics prescribed for outpatient care are not appropriate.

The study shows that taking antibiotics increases the risk for kidney stones and the risk is greatest among young people. “Consequently, these results suggest that the risk of nephrolithiasis may be decreased by reducing inappropriate antibiotic exposure and choosing alternative antibiotics, particularly for those patients who are at increased risk of stone formation,” said Dr. Tasian.

Study co-authors include Lawrence Copelovitch, MD, Thomas Jemielita, PhD, David S. Goldfarb, MD, Jeffrey Gerber MD, PhD, MSCE, and Qufei Wu, MS.

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