Motor neurone disease

Is frequent antibiotic use a risk factor for MND?

Antibiotics use and risk of amyotrophic lateral sclerosis in Sweden.

Sun J, Zhan Y, Mariosa D, et al.

Eur J Neurol 2019; 26:1355-1361.



Previous animal studies have suggested a disrupted intestinal microbiome in amyotrophic lateral sclerosis (ALS). Due to the known effect of antibiotics on gut microflora, the potential role of antibiotics use on the risk of ALS deserves an investigation.


A nested case-control study was conducted using several Swedish national registers. In all, 2484 ALS patients diagnosed between 1 July 2006 and 31 December 2013 were included as cases, and five controls per case individually matched to the case by sex, birth year and area of residence were randomly selected from the general Swedish population. Information on antibiotics prescriptions before ALS diagnosis was extracted from the Prescribed Drug Register for both cases and controls. A conditional logistic regression model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).


After accounting for potential diagnostic delay in ALS by excluding all prescriptions within 1 year before diagnosis, any antibiotics use was associated with a higher risk of ALS. The ORs (95% CIs) were 1.06 (0.94-1.19), 1.13 (1.00-1.28) and 1.18 (1.03-1.35) when comparing 1, 2-3 and ≥4 prescriptions to no prescription (P for trend = 0.0069). Similar results were noted for antibiotics used for respiratory infections and urinary tract as well as skin and soft tissue infections. Amongst different individual antibiotics, the risk of ALS was especially increased in relation to more than two prescriptions of beta-lactamase sensitive penicillin (OR 1.28; 95% CI 1.10-1.50).


Use of antibiotics, especially repeated, might be associated with a higher subsequent risk of ALS.

This paper is now cited in the neurochecklist:

Motor neurone disease (MND): environmental risk factors

Abstract link

Antibiotic Drug. Global panorama on Flickr.

By Ibrahim Imam

I am a UK Neurologist keen on general neurology, but with an interest in neuromuscular diseases. I maintain the neurology searchable database, I also blog at I share and discuss current issues around clinical neurology. I hope you find my blogs enlightening, practical, and even entertaining.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s