Adrian J. Lowe, MSc, PhD, on the Impact of Early-Life Antibiotic Exposure on Later-Life Lung Function

The impact of early postnatal exposure to antibiotics on the development of asthma has been widely debated over the years. It is also unknown whether different antibiotic classes affect this association or whether children with certain genetic mutations have a greater risk.

To explore these associations, a research team led by Adrian J. Lowe, BSc (Hons), MSc, PhD—who is an associate professor and principal research fellow in the Allergy and Lung Health Unit at the Melbourne School of Population and Global Health at the University of Melbourne in Australia—analyzed parent-reported data of childhood antibiotic use from birth to 2 years of age.1

Here are his answers to our burning questions.

PULM CON: For your study, you and your colleagues examined whether antibiotic exposure during early life impairs lung function later in life. Can you give us an overview of your study and how it came about?

Adrian Lowe: Previous studies have suggested a possible link between early life antibiotic use and increased risk of asthma, possibly due to the effect of these medications on the child's developing gut microbiome. Prior to our research, no study had examined the relationship between antibiotics given in early life and lung function outcomes in early adulthood. Attaining maximal lung growth in early life is important for long-term health. In our Melbourne Atopy Cohort Study (MACS), which recruited 620 participants in the early 1990s, we had fantastic data from the first 2 years of life when children were exposed to antibiotics, for how long, and why.  Coupled with this, we had lung function data (spirometry) measured at both 12 and 18 years of age. This allowed us to explore this issue in very robust manner.

PULM CON: Let’s talk more about your results. How did early exposure to antibiotics affect lung function later in life?

AL: Put simply, we did not find evidence to support that increasing exposure, or earlier exposure, to antibiotics adversely impacted lung function outcomes in adolescence and early adulthood. It should be noted that almost all of the children in our cohort received antibiotics, so I cannot comment on these relationships for any vs no antibiotic exposure.

PULM CON: Did the type of antibiotic or duration of treatment affect your results at all?

AL: When we looked at the potential effects of specific types of antibiotics (for groups including penicillin, macrolides, sulfonamides, and cephalosporins), we again did not find evidence that increasing use of these medications were associated with lung function outcomes.  

PULM CON: What are your thoughts regarding antibiotic stewardship in light of your results?

AL: Over recent decades, there has been increasing recognition of the importance of rationalizing the use of antibiotics and ensuring that their use is likely to give clinical benefit.  We strongly support this rationalization, particularly in light of the growing threat of antibiotic-resistant bacteria.  

PULM CON: What are the clinical implications of your results? How might your results impact clinicians?

AL: Our findings are relatively reassuring for the management of bacterial infections in young children. We found that increasing treatment with antibiotics was not associated with a clinically important detrimental impact on lung function into early adulthood. While there are very good reasons to ensure appropriate use of antibiotics in young children, our evidence suggests that parents and clinicians should not be unduly concerned that antibiotics will adversely impact on lung function.  



  1. dos Santos K, Lodge CJ, Abramson MJ, et al. Early-life exposure to oral antibiotics and lung function into early adulthood. CHEST. 2020;157(2):334-341.