@article{8688795,
  abstract     = {{Background It is understudied whether the posed association of oral antibiotics with colorectal cancer (CRC) varies between antibiotic spectrums, colorectal continuum, and if a non-linear dose-dependent relationship is present. Design Three electronic databases and a trial platform were searched for all relevant studies, from inception until February 2020, without restrictions. Random-effects meta-analyses provided pooled effect-sizes (ES) with 95% confidence intervals (CI). Dose-response analyses modelling the relationship between number of days exposed to antibiotics and CRC risk were extended to non-linear multivariable random-effects models. Results Of 6483 identified publications ten were eligible, including 4.1 million individuals and over 73,550 CRC cases. The pooled CRC risk was increased among individuals who ever-used antibiotics (ES = 1.17, 95%CI 1.05-1.30), particularly for broad-spectrum antibiotics (ES = 1.70, 95%CI 1.26-2.30), but not for narrow-spectrum antibiotic (ES = 1.11, 95% 0.93-1.32). The dose-response analysis did not provide strong evidence of any particular dose-response association, and the risk patterns were rather similar for colon and rectal cancer. Discussion The antibiotic use associated CRC risk seemingly differs between broad- and narrow-spectrum antibiotics, and possibly within the colorectal continuum. It remains unclear whether this association is causal, requiring more mechanistic studies and further clarification of drug-microbiome interactions.}},
  author       = {{Simin, Johanna and Fornes, Romina and Liu, Qing and Olsen, Renate Slind and Callens, Steven and Engstrand, Lars and Brusselaers, Nele}},
  issn         = {{0007-0920}},
  journal      = {{BRITISH JOURNAL OF CANCER}},
  keywords     = {{BREAST-CANCER,INFLAMMATION,MICROBIOME,INFECTION,EXPOSURE,BIAS}},
  language     = {{eng}},
  number       = {{12}},
  pages        = {{1825--1832}},
  title        = {{Antibiotic use and risk of colorectal cancer : a systematic review and dose-response meta-analysis}},
  url          = {{http://doi.org/10.1038/s41416-020-01082-2}},
  volume       = {{123}},
  year         = {{2020}},
}

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