Title : The association between antibiotic exposure and the incidence of multiple sclerosis: A systematic review and meta-analysis
Abstract:
Background: Multiple Sclerosis (MS) is a complex autoimmune inflammatory disease of the central nervous system with an incompletely understood etiology. Emerging evidence suggests a critical link between gut microbiome disruption and MS pathogenesis, with antibiotics potentially playing a significant role in microbiome alterations. There is conflicting evidence regarding the association between antibiotic exposure and MS diagnosis. We conducted a systematic review and meta-analysis to explore the relationship between antibiotic usage and the risk of developing MS.
Methods: A comprehensive systematic review was conducted across four electronic databases, searching for studies until March 23, 2025. The meta-analysis included comparative studies examining antibiotic usage frequency prior to MS onset in MS patients versus control group. Adjusted odds ratios (OR) were pooled using the generic inverse variance method with corresponding 95% confidence intervals. A subgroup analysis was performed based on antibiotic type.
Results: The analysis encompassed eight reports involving 90,576 participants (20,758 MS cases and 69,818 controls), with a female representation of 67%. A statistically significant association was observed between antibiotic exposure and MS risk (OR=1.16; 95% CI [1.02-1.32]; P=0.02). Stratified analysis revealed significant associations for multiple antibiotic classes, including tetracyclines (P=0.004), macrolides (P<0.00001), quinolones (P<0.00001), nitrofurantoin (P<0.00001), aminoglycosides (P=0.008), metronidazole (P=0.0002), sulfonamides (P<0.00001), and antimycotics (P=0.03).
Conclusion: This meta-analysis demonstrates a notable correlation between specific antibiotic exposures and MS incidence. However, causal relationships remain unconfirmed. Longitudinal prospective studies are necessary to definitively establish whether antibiotic exposure represents a genuine MS risk factor.This meta-analysis demonstrates a notable correlation between specific antibiotic exposures and MS incidence. However, causal relationships remain unconfirmed. Longitudinal prospective studies are necessary to definitively establish whether antibiotic exposure represents a genuine MS risk factor.
