This systematic review and meta-analysis evaluated 31 studies including 422,350 patients and found that antibiotic exposure was associated with a higher incidence of new-onset IBS. Overall, IBS developed in 26% of antibiotic users vs. 20% of non-users (incidence rate ratio [IRR], 1.30; 95% confidence interval [CI], 1.07–1.58; p=0.008). In sensitivity analyses limited to patients who received antibiotics specifically for GI infections, the risk was even greater (IRR, 1.71; 95% CI, 1.16–2.51; p=0.007), though heterogeneity across studies was high. These data support concerns that antibiotic-related microbiome disruption may contribute to post-infectious gut–brain dysfunction and persistent symptoms. While causality cannot be confirmed due to the observational nature of the included studies, the consistency of findings underscores the importance of antibiotic stewardship in acute diarrheal illnesses.
Clinical takeaway: Reserve antibiotics for GI infections with clear indications, as exposure may increase the long-term risk of post-infectious IBS.
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