{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T16:10:31Z","timestamp":1780416631094,"version":"3.54.1"},"reference-count":43,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-017"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-037"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-012"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-029"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"stm-asf","delay-in-days":0,"URL":"https:\/\/doi.org\/10.15223\/policy-004"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","msard-journal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Multiple Sclerosis and Related Disorders"],"published-print":{"date-parts":[[2026,3]]},"DOI":"10.1016\/j.msard.2025.106936","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T16:57:50Z","timestamp":1765904270000},"page":"106936","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["The association between antimicrobial exposure and subsequent multiple sclerosis risk: A systematic review and meta-analysis"],"prefix":"10.1016","volume":"107","author":[{"given":"Hassan K.","family":"Salamatullah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lamar","family":"AboAljadiel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mumen H.","family":"Halabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shatha","family":"Alqurashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahaf","family":"Aljohani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danya","family":"Aljafari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Alkhiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed A.","family":"Almaghrabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0892-8669","authenticated-orcid":false,"given":"Seraj","family":"Makkawi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.msard.2025.106936_bib0001","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1007\/s10072-017-3080-9","article-title":"Multiple sclerosis and environmental risk factors: a case-control study in Iran","volume":"38","author":"Abbasi","year":"2017","journal-title":"Neurol. Sci."},{"key":"10.1016\/j.msard.2025.106936_bib0002","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1111\/ane.12958","article-title":"Infectious exposure, antibiotic use, and multiple sclerosis: a population-based incident case-control study","volume":"138","author":"Abdollahpour","year":"2018","journal-title":"Acta Neurol. Scand."},{"key":"10.1016\/j.msard.2025.106936_bib0003","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1007\/s10654-009-9367-2","article-title":"A population-based case\u2013control study on viral infections and vaccinations and subsequent multiple sclerosis risk","volume":"24","author":"Ahlgren","year":"2009","journal-title":"Eur. J. Epidemiol."},{"key":"10.1016\/j.msard.2025.106936_bib0004","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1093\/aje\/kwj123","article-title":"Antibiotic use and risk of multiple sclerosis","volume":"163","author":"Alonso","year":"2006","journal-title":"Am. J. Epidemiol."},{"key":"10.1016\/j.msard.2025.106936_bib0005","doi-asserted-by":"crossref","first-page":"942","DOI":"10.3390\/nu15040942","article-title":"Gut-microbiota, and multiple sclerosis: background, evidence, and perspectives","volume":"15","author":"Altieri","year":"2023","journal-title":"Nutrients."},{"key":"10.1016\/j.msard.2025.106936_bib0006","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1159\/000515682","article-title":"Antibiotic use and risk of multiple sclerosis: a nested case-control study in Emilia-Romagna Region, Italy","volume":"55","author":"Baldin","year":"2021","journal-title":"Neuroepidemiology."},{"key":"10.1016\/j.msard.2025.106936_bib0007","first-page":"471","article-title":"The response of the lymphatic tissue to the microbial flora. Studies on germfree mice","volume":"42","author":"Bauer","year":"1963","journal-title":"Am. J. Pathol."},{"key":"10.1016\/j.msard.2025.106936_bib0008","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.cell.2014.03.011","article-title":"Role of the microbiota in immunity and inflammation","volume":"157","author":"Belkaid","year":"2014","journal-title":"Cell"},{"key":"10.1016\/j.msard.2025.106936_bib0009","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1212\/WNL.0000000000000768","article-title":"Atlas of multiple sclerosis 2013: a growing global problem with widespread inequity","volume":"83","author":"Browne","year":"2014","journal-title":"Neurology."},{"key":"10.1016\/j.msard.2025.106936_bib0010","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1016\/j.chom.2013.10.004","article-title":"Intestinal microbial diversity during early-life colonization shapes long-term IgE levels","volume":"14","author":"Cahenzli","year":"2013","journal-title":"Cell Host. Microbe"},{"key":"10.1016\/j.msard.2025.106936_bib0011","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.1152\/physrev.00018.2018","article-title":"The microbiota-gut-brain axis","volume":"99","author":"Cryan","year":"2019","journal-title":"Physiol. Rev."},{"key":"10.1016\/j.msard.2025.106936_bib0012","doi-asserted-by":"crossref","DOI":"10.1016\/j.msard.2025.106366","article-title":"Antibiotic drug use in the five years preceding the diagnosis of multiple sclerosis","volume":"96","author":"Darvishi","year":"2025","journal-title":"Mult. Scler. Relat. Disord."},{"key":"10.1016\/j.msard.2025.106936_bib0013","doi-asserted-by":"crossref","first-page":"e280","DOI":"10.1371\/journal.pbio.0060280","article-title":"The pervasive effects of an antibiotic on the human gut microbiota, as revealed by deep 16S rRNA sequencing","volume":"6","author":"Dethlefsen","year":"2008","journal-title":"PLoS. Biol."},{"key":"10.1016\/j.msard.2025.106936_bib0014","doi-asserted-by":"crossref","first-page":"4554","DOI":"10.1073\/pnas.1000087107","article-title":"Incomplete recovery and individualized responses of the human distal gut microbiota to repeated antibiotic perturbation","volume":"108","author":"Dethlefsen","year":"2011","journal-title":"Proc. Natl. Acad. Sci. U.S.A."},{"key":"10.1016\/j.msard.2025.106936_bib0015","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"10.1016\/j.msard.2025.106936_bib0016","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000033906","article-title":"Relationship between medical history and multiple sclerosis: a-case-control study","volume":"102","author":"Esfandiari","year":"2023","journal-title":"Medicine"},{"key":"10.1016\/j.msard.2025.106936_bib0017","series-title":"Cochrane Handbook for Systematic Reviews of Interventions","year":"2019"},{"key":"10.1016\/j.msard.2025.106936_bib0018","doi-asserted-by":"crossref","DOI":"10.1016\/j.msard.2023.104765","article-title":"Antibiotic use and multiple sclerosis: a systematic review and meta-analysis","volume":"75","author":"Hosseinzadeh","year":"2023","journal-title":"Mult. Scler. Relat. Disord."},{"key":"10.1016\/j.msard.2025.106936_bib0019","doi-asserted-by":"crossref","first-page":"574","DOI":"10.5114\/pjr.2023.133677","article-title":"The diagnosis of multiple sclerosis: what has changed in diagnostic criteria?","volume":"88","author":"Jankowska","year":"2023","journal-title":"Pol. J. Radiol."},{"key":"10.1016\/j.msard.2025.106936_bib0020","doi-asserted-by":"crossref","first-page":"3216","DOI":"10.1099\/mic.0.040618-0","article-title":"Long-term impacts of antibiotic exposure on the human intestinal microbiota","volume":"156","author":"Jernberg","year":"2010","journal-title":"Microbiology"},{"key":"10.1016\/j.msard.2025.106936_bib0021","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1038\/ismej.2007.3","article-title":"Long-term ecological impacts of antibiotic administration on the human intestinal microbiota","volume":"1","author":"Jernberg","year":"2007","journal-title":"ISMe J."},{"key":"10.1016\/j.msard.2025.106936_bib0022","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s44197-025-00353-6","article-title":"Epidemiology of multiple sclerosis: global, regional, national and sub-national-level estimates and future projections","volume":"15","author":"Khan","year":"2025","journal-title":"J. Epidemiol. Glob. Health"},{"key":"10.1016\/j.msard.2025.106936_bib0023","doi-asserted-by":"crossref","DOI":"10.1073\/pnas.2411919121","article-title":"Global trends in antibiotic consumption during 2016\u20132023 and future projections through 2030","volume":"121","author":"Klein","year":"2024","journal-title":"Proc. Natl. Acad. Sci. U.S.A."},{"key":"10.1016\/j.msard.2025.106936_bib0024","first-page":"1662","article-title":"Induction of protective IgA by intestinal dendritic cells carrying commensal bacteria","volume":"303","author":"Macpherson","year":"2004","journal-title":"Science 1979"},{"key":"10.1016\/j.msard.2025.106936_bib0025","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1038\/s41582-021-00519-3","article-title":"The multiple sclerosis prodrome","volume":"17","author":"Makhani","year":"2021","journal-title":"Nat. Rev. Neurol."},{"key":"10.1016\/j.msard.2025.106936_bib0026","doi-asserted-by":"crossref","DOI":"10.18502\/cjn.v20i2.6744","article-title":"Medical history risk factors in primary progressive multiple sclerosis: a case-control study","author":"Maroufi","year":"2021","journal-title":"CJN"},{"key":"10.1016\/j.msard.2025.106936_bib0027","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.neuro.2016.03.020","article-title":"Factors associated with onset, relapses or progression in multiple sclerosis: a systematic review","volume":"61","author":"McKay","year":"2017","journal-title":"Neurotoxicology."},{"key":"10.1016\/j.msard.2025.106936_bib0028","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1093\/aje\/kwr201","article-title":"Use of penicillin and other antibiotics and risk of multiple sclerosis: a population-based case-control study","volume":"174","author":"Norgaard","year":"2011","journal-title":"Am. J. Epidemiol."},{"key":"10.1016\/j.msard.2025.106936_bib0029","doi-asserted-by":"crossref","first-page":"4624","DOI":"10.3390\/ijerph20054624","article-title":"Changes in gut microbiota and multiple sclerosis: a systematic review","volume":"20","author":"Ordo\u00f1ez-Rodriguez","year":"2023","journal-title":"IJERPH"},{"key":"10.1016\/j.msard.2025.106936_bib0030","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1067\/mai.2001.111142","article-title":"Antibiotic use during infancy promotes a shift in the TH1\/TH2 balance toward TH2-dominant immunity in mice","volume":"107","author":"Oyama","year":"2001","journal-title":"J. Allergy Clin. Immunol."},{"key":"10.1016\/j.msard.2025.106936_bib0031","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"10.1016\/j.msard.2025.106936_bib0032","doi-asserted-by":"crossref","first-page":"e1260","DOI":"10.1002\/mbo3.1260","article-title":"Impact of antibiotics on the human microbiome and consequences for host health","volume":"11","author":"Patangia","year":"2022","journal-title":"Microbiologyopen."},{"key":"10.1016\/j.msard.2025.106936_bib0033","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1001\/jama.295.6.676","article-title":"Comparison of two methods to detect publication bias in meta-analysis","volume":"295","author":"Peters","year":"2006","journal-title":"JAMa"},{"key":"10.1016\/j.msard.2025.106936_bib0034","doi-asserted-by":"crossref","first-page":"S77","DOI":"10.1093\/cid\/civ137","article-title":"Determining the long-term effect of antibiotic administration on the human normal intestinal microbiota using culture and pyrosequencing methods","volume":"60","author":"Rashid","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"10.1016\/j.msard.2025.106936_bib0035","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1080\/03007995.2017.1325575","article-title":"Allergies, antibiotics use, and multiple sclerosis","volume":"33","author":"Ren","year":"2017","journal-title":"Curr. Med. Res. Opin."},{"key":"10.1016\/j.msard.2025.106936_bib0036","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1177\/13524585231185045","article-title":"Exposure to systemic antibiotics in outpatient care and the risk of multiple sclerosis","volume":"29","author":"Sipil\u00e4","year":"2023","journal-title":"Mult. Scler."},{"key":"10.1016\/j.msard.2025.106936_bib0037","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1007\/BF01007234","article-title":"Pre-epithelial mucus layer in the colon of conventional and germ-free rats","volume":"22","author":"Szentkuti","year":"1990","journal-title":"Histochem. J."},{"key":"10.1016\/j.msard.2025.106936_bib0038","doi-asserted-by":"crossref","first-page":"3467","DOI":"10.21873\/invivo.12186","article-title":"Dominant antibiotic consumption patterns might be associated with the prevalence of multiple sclerosis in European countries","volume":"34","author":"Tern\u00e1k","year":"2020","journal-title":"Vivo"},{"key":"10.1016\/j.msard.2025.106936_bib0039","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2021.761408","article-title":"The multiple sclerosis prodrome: evidence to Action","volume":"12","author":"Tremlett","year":"2022","journal-title":"Front. Neurol."},{"key":"10.1016\/j.msard.2025.106936_bib0040","doi-asserted-by":"crossref","first-page":"20858","DOI":"10.1073\/pnas.0808723105","article-title":"Paneth cells directly sense gut commensals and maintain homeostasis at the intestinal host-microbial interface","volume":"105","author":"Vaishnava","year":"2008","journal-title":"Proc. Natl. Acad. Sci. U. S. A."},{"key":"10.1016\/j.msard.2025.106936_bib0041","series-title":"Handbook of Clinical Neurology","first-page":"151","article-title":"Infections and multiple sclerosis","author":"Venkatesan","year":"2014"},{"key":"10.1016\/j.msard.2025.106936_bib0042","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1177\/1352458518783662","article-title":"Five years before multiple sclerosis onset: phenotyping the prodrome","volume":"25","author":"Wijnands","year":"2019","journal-title":"Mult. Scler."},{"key":"10.1016\/j.msard.2025.106936_bib0043","doi-asserted-by":"crossref","first-page":"1536","DOI":"10.1128\/IAI.01104-10","article-title":"Antibiotic treatment alters the colonic mucus layer and predisposes the host to exacerbated Citrobacter rodentium -induced colitis","volume":"79","author":"Wlodarska","year":"2011","journal-title":"Infect. Immun."}],"container-title":["Multiple Sclerosis and Related Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2211034825006741?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2211034825006741?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T15:52:11Z","timestamp":1780415531000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2211034825006741"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":43,"alternative-id":["S2211034825006741"],"URL":"https:\/\/doi.org\/10.1016\/j.msard.2025.106936","relation":{},"ISSN":["2211-0348"],"issn-type":[{"value":"2211-0348","type":"print"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"The association between antimicrobial exposure and subsequent multiple sclerosis risk: A systematic review and meta-analysis","name":"articletitle","label":"Article Title"},{"value":"Multiple Sclerosis and Related Disorders","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.msard.2025.106936","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.","name":"copyright","label":"Copyright"}],"article-number":"106936"}}