Objective: To determine whether antibiotic exposure is associated with Parkinson’s disease (PD).

Background: Environmental exposures affect the risk of PD and it has been proposed that the gastrointestinal tract may be a possible entry point for such factors [1]. Gut microbiota alterations have been found in prodromal and established PD, but the cause of these alterations is unknown [2,3]. Antibiotic exposure can have long-term effects on the composition of human intestinal microbiota, and could be associated with PD risk.

Method: We evaluated the impact of antibiotic exposure on the risk of PD in a register-based case-control study. We identified all patients that were diagnosed with PD in Finland during the years 1998-2014. We obtained information on individual purchases of orally administered antibiotics during the years 1993-2014. We assessed the association between prior antibiotic exposure and PD with a conditional logistic regression.

Results: After exclusions, the study population consisted of 14074 PD-cases and 40993 controls. We found positive associations between oral antibiotic exposure and PD-risk that showed dependency on antibiotic class, antianaerobic coverage, antibacterial spectrum, number of antibiotic courses, and period of exposure. The connection was strongest for macrolides and lincosamides showing a dose-response relationship between antibiotic exposure and PD-risk with aOR reaching 1.427 (95% CI 1.063-1.916) for subjects that had purchased at least five courses 10-15 years before the index date.

Conclusion: Our results suggest that prior antibacterial exposure is associated with subsequent PD. It is plausible that oral antibiotic exposure makes the gastrointestinal tract more susceptible to PD pathology. Harmful long-term effects of exposure to commonly used oral antibiotics manifesting as neurodegeneration could have major implications for prescribing practices and public health.

References: 1. Hawkes CH, Del Tredici K, Braak H. Parkinson’s disease: a dual-hit hypothesis. Neuropathol Appl Neurobiol. 2007;33(6):599-614. 2. Scheperjans F, Aho V, Pereira PA, Koskinen K, Paulin L, Pekkonen E, et al. Gut microbiota are related to Parkinson’s disease and clinical phenotype. Mov Disord. 2015;30(3):350-8. 3. Heintz-Buschart A, Pandey U, Wicke T, Sixel-Doring F, Janzen A, Sittig-Wiegand E, et al. The nasal and gut microbiome in Parkinson’s disease and idiopathic rapid eye movement sleep behavior disorder. Mov Disord. 2018;33(1):88-98.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/antibiotic-exposure-and-risk-for-parkinsons-disease/