Antibiotics could reduce vaccination effectiveness in children

Antibiotics could reduce vaccination effectiveness in children

Child vaccination with a 6-fold combination vaccine. Taking antibiotics could reduce vaccine efficacy in children, new study suggests.

© Julian Stratenschulte / DPA

Can antibiotics have a negative effect on the effectiveness of vaccination in children? At least that’s what a US study suggests. Independent experts initially consider the thesis to be “conclusive”.

If young children are prescribed antibiotics, various vaccinations could have a worse effect. This is suggested by a US study, the results of which were published in the journal “Pediatrics”.

As the physicians suspect, an intestinal microbiome that has been thrown out of balance by the antibiotics could impair the success of the vaccination – an argument that, according to German experts, is conclusive. The interaction of microorganisms in the intestine is important for digestion, among other things, but also for the immune system.

Antibiotics could interfere with the vaccine’s effectiveness

In fact, a 2019 study previously reported that antibiotics can reduce the effectiveness of vaccinations in adults. A team led by physicians Timothy Chapman and Michael Pichichero from the Rochester General Hospital Research Institute analyzed blood samples from 560 children over a period of 6 to 24 months. The samples had been taken as part of several check-ups and when an acute middle ear infection occurred. 342 children from this cohort had received a total of almost 1700 units of antibiotics in the first 24 months of life, while 218 children received none.

The researchers then analyzed the children’s antibody levels for the diphtheria, tetanus, polio, whooping cough, influenza and pneumococcal vaccines. The result: The antibody levels in the children treated with antibiotics were, on average, lower than in those who had not received antibiotics.

Immune protection not relevant trained

In those children who received antibiotics between the ages of nine and twelve months or repeatedly, these levels were particularly often below the concentrations considered relevant for immune protection. “This would put them at an increased risk of contracting infections caused by the pathogens against which they were vaccinated,” explains Ulrich Schaible, Director of the Infections program at the Borstel Research Center, in an independent assessment.

A more differentiated look at the results shows that the antibiotic amoxicillin alone had no effect, but in combination with clavulanic acid it did. Such combination drugs are prescribed due to their expanded antibacterial spectrum of action. “It is also interesting that the combination of amoxicillin and clavulanate had a lesser effect on antibody production after five days than after administration for ten days,” notes Schaible: “So giving antibiotics for a shorter period seems to be better.”

Immunological response is complex

However, the expert also emphasizes that the influence of the diseases for which the antibiotics were given on the formation of antibodies after vaccination should be analyzed independently of the antibiotic administration. That would mean screening children with similar conditions who weren’t receiving antibiotics. In addition, antibodies are only part of the immunological response to a vaccine, adds Claudius Meyer from the University Medical Center Mainz: “The T-cell-mediated immune memory was not examined in the study, but according to reasonable understanding it will also have been induced and thus have a protective effect can mediate.”

As the authors themselves write, they did not take any stool samples from the children. However, these are necessary to determine the effects of antibiotics on the intestinal microbiome.

Intestinal microbiome is disrupted

“Antibiotics, which are often prescribed in early childhood against middle ear infections, not only attack the dangerous bacteria in the ear, but also the beneficial bacteria in the intestinal microbiome,” says Cornelia Gottschick from the University of Halle-Wittenberg, describing the underlying connection. “The balance between the bacteria and our immune system is disturbed as a result and it is conceivable that vaccinations are no longer fully effective, which can lead to reduced immune protection.” That connection remains theoretical in the current study, since the intestinal microbiome was not examined.

Possibly, taking probiotics to protect the intestinal microbiome could reduce the effect observed in the study, Gottschick continued. However, this still needs to be researched.

Is a booster vaccination necessary?

It is also not possible to say at this time whether the children treated with antibiotics should be boosted, Meyer adds: “It might be helpful to have a follow-up check at the age of three or five to identify the need for a booster.” In some countries, some of the vaccines under consideration would be boosted during childhood anyway. “Only a follow-up study with the same children can show whether the children who received antibiotics could still be distinguished from the control group after a booster vaccination.”

All in all, the new study provides elegant proof of the problematic side effects of antibiotics, summarizes Meyer: “Not only the development of resistance when antibiotics are administered, but also the physiological effects must prompt us to use antibiotics carefully in childhood and limit them to what is absolutely necessary. “


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