Antibiotic Administration and Risk of Multiple Sclerosis: a Systematic Review and Meta-Analysis.

Abstract

<h4>Background</h4>Gut-brain axis is a bidirectional interaction between the gut and the nervous system. Antibiotics disrupt this axis. We designed this systematic review and meta-analysis to show if there is an association between antibiotic administration and the risk of multiple sclerosis (MS).<h4>Methods</h4>PubMed, Scopus, EMBASE, PsycINFO, Web of Science and Google Scholar were systematically searched by two independent researchers on February 1^st 2025. The first author of the publication, country of the study, publication year, number of study participants, total female and male population, total use and types of antibiotics were extracted.<h4>Results</h4>A literature search revealed 3606 records, 22 full texts were evaluated and finally, six studies remained for systematic review. The pooled odds ratio (OR) for the use of penicillin and MS risk was 1.01 [95% confidence interval (CI): 0.84-1.22] (I²=81.6%, P<0.001). The pooled OR for the use of tetracycline and MS risk was 1.20 (95% CI: 1.02-1.4) (I²=82.8%, P<0.001). The pooled OR for the use of sulfonamides and MS risk was 1.30 (95%CI: 1.23-1.38) (I²=22.1%, P<0.001). The pooled OR for the use of macrolides and MS risk was 1.19 (95% CI: 1.07-1.32) (I²=71.3%, P=0.01). The pooled OR for the use of quinolones and MS risk was 1.24 (95% CI: 1.18-1.30) (I²=7.8%, P=0.001).<h4>Conclusions</h4>The results of this systematic review and meta-analysis show that, except for penicillin, the use of other antibiotics may increase the risk of MS.