Do Oral Antibiotics Play a Role in Kidney Stone Prevalence Increase in Youth?

The findings:

Children and adults treated with five classes of oral antibiotics have a significantly higher risk of developing kidney stones. The five classes include oral sulfas, cephalosporins, fluoroquinolones, nitrofurantoin, and broad-spectrum penicillins. Patients who received sulfa drugs were more than twice as likely as those not exposed to antibiotics to have kidney stones. For broad-spectrum penicillins, the increased risk was 27 percent higher. The strongest risks appeared at younger ages and among patients most recently exposed to antibiotics. The risk of kidney stones decreased over time but remained elevated several years after antibiotic use.

Why it matters:

The overall prevalence of kidney stones has risen by 70 percent over the past 30 years, with sharp increases among adolescents and young women. Previously, kidney stones were rare in children. This is the first time that some oral antibiotics have been linked to this condition, and the study suggests that exposure to them might contribute to the rising incidence of kidney stones, particularly among children. The new findings also reinforce the need for clinicians to promote antibiotic stewardship and be careful in prescribing correct antibiotics.

Who conducted the study:

The study’s co-authors from Children’s Hospital of Philadelphia included Gregory Tasian, MD, MSCE, a pediatric urologist and epidemiologist; Michelle Denburg, MD, MSCE, a pediatric nephrologist; and Jeffrey Gerber, MD, PhD, an infectious disease specialist. They are members of Clinical Futures, a CHOP Research Institute Center of Emphasis, and the Center for Clinical Epidemiology and Biostatistics in the Perelman School of Medicine at the University of Pennsylvania. The study team also included Lawrence Copelovitch, MD, an attending physician in the Division of Nephrology at CHOP, and colleagues from Penn, New York University Langone Medical Center, and Merck & Co.

How they did it:

The study team drew on electronic records from the United Kingdom, covering 13 million adults and children seen by general practitioners in The Health Improvement Network between 1994 and 2015. The researchers analyzed prior antibiotic exposure for nearly 26,000 patients with kidney stones, compared to nearly 260,000 control subjects.

Quick thoughts:

“Our findings suggest that antibiotic prescription practices represent a modifiable risk factor — a change in prescribing patterns might decrease the current epidemic of kidney stones in children,” Dr. Tasian said.

What's next:

Scientists already knew that antibiotics alter the composition of the microbiome — the community of microorganisms in the body. Disruptions in the intestinal and urinary microbiome have been linked to the occurrence of kidney stones. Dr. Tasian and colleagues are continuing to investigate the microbiomes of children and adolescents with kidney stones in a single-center study at CHOP. Their goal is to expand this research into broader, population-based studies to better understand how variations in microbiome composition may influence the development of kidney stones.

Where the study was published:

Journal of the American Society of Nephrology

Where to learn more:

Read the CHOP press release. Various local and national media outlets also featured the novel research, including the New York Times, TIME, Philly.com, and more. See our previous coverage on Cornerstone about the epidemic of kidney stones in children. And find out about the new Urinary Stone Disease Research Network co-led by Dr. Tasian.