19 Nov Antibiotic Awareness – Know the risks and benefits
There is no doubt that antibiotics have been one of the most significant life-saving breakthroughs in modern medicine. As helpful as they are, unfortunately, they are not without risk.
In 2018, the most commonly prescribed class of medication was antibiotics. In fact, between 2000 and 2015, antibiotic prescriptions increased by nearly 40%. A 2016 study published in the Journal of American Medicine (JAMA) found that at least 30% (other sources claim 50%) of all antibiotics prescribed in the U.S. (to the tune of more than 80 million prescriptions per year) “are given without an appropriate indication”.
In addition to human use, use in livestock is skyrocketing as well.
A recent World Health Organization survey found that almost two thirds of those surveyed were misinformed about the benefits of antibiotics; believing that they can be used to treat colds and flu. Antibiotics are ineffective in the case of viral illnesses: including colds, flu, most cases of sore throats and coughs, and many ear infections.
One of our primary concerns regarding frequent antibiotic use is the evolution of antibiotic resistant bacteria. Every year, as many as 2 million people in the US become infected with an antibiotic-resistant bacteria resulting in at least 23,000 deaths.Throughout the world, these numbers are increasing at an alarming rate. Unfortunately, the release of novel antibiotics is almost at a standstill. We are truly dealing with a public health crisis.
Interestingly, newer research suggests that shorter duration of antibiotic use may be as effective at curing the infection while also reducing the risk of antibiotic resistance. This challenges the old notion of needing to finish out the entire course of antibiotics.
A second important risk associated with antibiotic use is the alterations these medications can cause in the gut microbiome. We are increasingly learning that antibiotic use (particularly in early infancy) can significantly shift the balance of bacteria in the gut. Such shifts are associated with increased risks of allergies, asthma, metabolic dysfunction, and obesity in childhood in proportion with the number of prescriptions of antibiotics in early childhood.
Interestingly, some research suggests that taking a probiotic supplement while on antibiotics actually slows the return of the gut microbiome to normal. One exception would be a yeast probiotic called Saccharomyces Boulardii which may reduce the risk of the growth of a GI microbe called C. diff which is the cause of post-antibiotic diarrhea.
Here’s a piece of good news: research out of Oregon State University found that those children exposed to heavy antibiotic use in early childhood but then avoiding antibiotics could recover their microbiome within 2 years.
A third and increasingly concerning risk of antibiotic use is their potential impact on mitochondria. These “powerhouses of our cells” produce the energy which drives each of our cells. Mitochondria are actually very similar in structure to bacterial cells. Mitochondrial damage can be absolutely devastating to the body. Because mitochondria are concentrated in the brain and heart, the most common symptoms of mitochondrial toxicity are fatigue, brain fog and neurological deficits, nerve damage and cardiovascular effects. Broad spectrum antibiotics are sometimes necessary (for example, when the cause of the infection is unknown) but they also among the most toxic to our mitochondria. In this class are the fluoroquinolone antibiotics (such as ciprofloxacin (Cipro) and levofloxacin (Levaquin)) which can cause severe and permanent injury in some patients. In fact, lawsuits against the manufacturers of these antibiotics abound. These drugs should not be used for treatment of the run-of-the-mill sinus infection or bronchitis. They should be reserved for severe infections requiring a broad-spectrum approach.
Some takeaway tips:
- Ask your doctor whether you can take a watch and wait approach: waiting a few days to see whether the infection will resolve itself OR waiting for culture results to make sure the infection is indeed bacterial.
- Ask your doctor to prescribe a narrow-spectrum antibiotic which is most likely to target the infection in question.
- Consume fermented foods (such as kimchi, tempeh, miso, sauerkraut) and foods high in soluble fiber to support the growth of good bacteria in your gut.
- If you’re ill, visit your primary care doctor. A 2018 study published in JAMA revealed patients were five times more likely to be prescribed an unnecessary antibiotic at an urgent care or retail health clinic than if they went to their family medicine physician or to the emergency room.
- Take care of the basics so you can prevent illness and recover quickly if you do get sick:
1.A healthy diet high in vegetables, fruits, and healthy fats
2.Vitamin D from sun-exposure or a supplement
3.Get 7-9 hours of sleep a night
4.Wash hands with soap and warm water before eating (avoid the use of antibacterial wipes or hand sanitizers).
5.Similar to hand washing, gargling help to reduce the risk of an upper respiratory infection and the duration of an infection if it occurs.
Here’s to your health!