Don’t Use Antibiotics Unless Necessary

Until the discovery of antibiotics, countless numbers of people of all ages were seriously harmed or killed by infectious bacteria. It was not uncommon for small, local bacterial infections to evolve into systemic illnesses that ravaged the entire body. Sometimes, serious medical problems, such as bacterial pneumonia, became a rapid death sentence. The untimely passing of children, teens, and young adults from problems related to infectious diseases was a fairly common occurrence.

Then, in the 1920s, Alexander Fleming, a British scientist who was working in a laboratory at St. Mary’s Hospital in London, discovered that a naturally growing substance could attack and trigger the elimination of certain bacteria. Fleming found that when Staphylococcus aureus, a common bacterium, was placed in the same petri dish as mold, the bacterium was damaged or destroyed. The mold made a substance, which Fleming called penicillin, that could wipe out bacteria.

Soon, other researchers were also conducting experiments on penicillin in both animals and humans. It was evident that penicillin was saving lives and improving the outcomes of many illnesses. Not surprisingly, drug companies began to develop other antibiotics. Today, there are dozens of different antibiotics. It has been estimated that at least 150 million prescriptions for antibiotics are written each year. ¹ The number is probably much higher. Some of the more common antibiotics are azithromycin, amoxicillin, amoxicillin/clavulinic acid (augmentin), ciprofloxacin, and cephalexin.

In a study published in 2014 in the Journal of Antimicrobial Chemotherapy, researchers from the United Kingdom wanted to learn if they could reduce the duration of antibiotic therapy in patients with lower respiratory infections. According to these researchers, it is not uncommon for people with lower respiratory infections to be treated with antibiotics for “prolonged” periods of time. For one year, the researchers followed over 500 patients with lower respiratory tract infections. During the first six months, the researcher observed how the patients used their antibiotics; during the second six months, patients were placed on a new prescribing protocol. In the new protocol, there were automatic stop dates, time limits on prescriptions, and support from pharmacists. Throughout the study, the researchers monitored antibiotic side effects, length of hospital stays, and patient deaths. The results were notable. When the patients followed the new protocol, they used 18.1 percent fewer antibiotics, and they had a 39.3 percent reduction in antibiotic-related side effects. The researchers concluded that “a simple intervention can significantly reduce antibiotic duration and antibiotic-related side effects.” ³

In an article published in 2011 in Nature, Martin Blaser, MD, chair of the Department of Medicine, New York University Langone Medical Center in New York City, noted that not all bacteria are bad, especially those in the gastrointestinal tract. And, even a short course of antibiotics can drastically reduce the number of bacteria in the gut. This, in turn, may trigger a difficult-to-cure case of diarrhea or a worse medical problem. Sometimes the friendly bacteria never fully recover. “Evidence is accumulating that our welcome residents [friendly bacteria] do not, in fact, recover completely.” Why is that so important? According to Dr. Blaser, by the time the average child has matured into an 18-year-old teen, he or she has received 10 to 20 courses of antibiotics. ⁵

In a population case-controlled study published in 2013 in BMC Gastroenterology, researchers based in Sweden examined the association between exposure to antibiotics and the development of celiac disease, a common autoimmune disorder in which products containing gluten must be eliminated from the diet. In order to examine the relationship between the use of systemic antibiotics and the subsequent development of celiac disease, the researchers obtained histopathology data on 2,933 people with celiac disease. They also reviewed antibiotic use in 2,118 people with inflammation and 620 people with normal mucosa but positive celiac disease serology. All of the participants were matched for age and sex with 28,262 controls. The researchers noted that they “hypothesized a positive association between antibiotic use and CD.” And, they did indeed find a positive relationship between antibiotic use and the subsequent development of celiac disease. Moreover, “antibiotic exposure was also linked to small-intestinal inflammation and to normal mucosa with positive CD serology, both of which may represent early CD.” How does this happen? The researchers suggested that antibiotics may alter the gut microbiota. ⁶

In a study that was published in 2013 in the International Journal of Obesity, researchers from several New York University departments wanted to learn if the exposure of infants to antibiotics affected their early-life body mass. The cohort consisted of 11,532 children from the Avon Longitudinal Study of Parents and Children. The researchers found that nearly one-third of these children received antibiotics between the time they were born and six months of age. On the other hand, by the age of two years, 25.7 percent of the children had not taken any antibiotics. The researchers learned that exposure to antibiotics early in life was associated with increases in body mass. For example, “at 38 months, children who had been exposed to antibiotics during the earliest period had significantly higher standardized BMI scores, and were 22 percent more likely to be overweight than children who had not been exposed.” ⁸

In a study published in 2011 in the journal Pediatrics, researchers from Utah, California, and Pennsylvania wanted to learn more about the antibiotic prescribing practices in ambulatory pediatrics. The researchers used 2006 to 2008 data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, which are nationally representative samples of ambulatory care visits in the United States. During this time period, there were 64,753 sampled visits in these surveys. The researchers determined that antibiotics were prescribed in 21 percent of the pediatric ambulatory visits. In 23 percent of these visits, the patients had respiratory conditions “for which antibiotics were not clearly indicated.” Moreover, the medical providers frequently prescribed “broad-spectrum antibiotics, which are often inappropriate. The researchers commented that this inappropriate use of broad-spectrum antibiotics “raises serious concerns about the overuse of broad-spectrum antibiotics, particularly for patients for whom antibiotics therapy is not indicated at all.” The overuse of broad-spectrum antibiotics is problematic; “these agents are prescribed unnecessarily, have high cost, and promote bacterial resistance.” ¹⁰

In a retrospective study published in 2015 in the Journal of the Pediatric Infectious Diseases Society, researchers from different locations in Pennsylvania noted that the most common reason for prescribing antibiotics is to treat outpatient respiratory tract infections. As a result, the researchers wanted to learn more about outpatient antibiotic prescribing practices. The cohort consisted of 25 distinct but diverse pediatric practices with 222 clinicians. The practices varied markedly in racial characteristics and payer types. Data were obtained from January 1 until December 31, 2009. The researchers found that a total of 28 percent of acute visits resulted in antibiotic prescriptions. But, the prescribing practices ranged from 18 percent to 36 percent of acute visits. Certain practices appeared to be more likely to prescribe antibiotics than other practices. “Compared with a child seeking care at a low-antibiotic use practice, a similar child visiting a high use practice is twice as likely to receive an antibiotic prescription at any acute visit.” The researchers concluded that “antibiotic prescribing for common pediatric infections varied substantially across practices.” ¹¹

1. American Academy of Pediatrics, healthychildren.org.

2. Phil Whitaker, “If We Don’t Treat Antibiotics with Respect, Hoping to Avoid Resistance Will Be Futile,” New Statesman, January 10, 2014: 67.

3. Colin Murray, Arlene Shaw, Matthew Lloyd et al., “A Multidisciplinary Intervention to Reduce Antibiotic Duration in Lower Respiratory Tract Infections,” Journal of Antimicrobial Chemotherapy 69, no. 2 (2012): 515-18.

4. Ilseung Cho, Shingo Yamanishi, Laura Cox et al., “Antibiotics in Early Life Alter the Murine Colonic Microbiome and Adiposity,” Nature 488 (2012): 621-26.

5. Martin Blaser, “Stop the Killing of Beneficial Bacteria,” Nature 476 (2011): 393-94.

6. Karl Mårild, Weimin Ye, Benjamin Lebwohl et al., “Antibiotic Exposure and the Development of Coeliac Disease: A Nationwide Case-Control Study,” BMC Gastroenterology 13 (2013): 109+.

7. R. Murphy, A. W. Stewart, I. Braithwaite et al., “Antibiotic Treatment During Infancy and Increased Body Mass Index in Boys: An International Cross-Sectional Study,” International Journal of Obesity 38 (2014): 1115-19.

8. L. Trasande, J. Blustein, M. Liu et al., “Infant Antibiotic Exposures and Early-Life Body Mass,” International Journal of Obesity 37 (2013): 16-23.

9. J. P. Donnelly, John W. Baddley, and H. E. Wang, “Antibiotic Utilization for Acute Respiratory Tract Infections in U. S. Emergency Departments,” Antimicrobial Agents and Chemotherapy 58, no. 3 (2014): 1451-57.

10. Adam L. Hersh, Daniel J. Shapiro, Andrew T. Pavia, and Samir S. Shah, “Antibiotic Prescribing in Ambulatory Pediatrics in the United States,” Pediatrics 128, no. 6 (2011): 1053-61.

11. Jeffrey S. Gerber, Priya A. Prasad, A. Russell Localio et al., “Variation in Antibiotic Prescribing Across a Pediatric Primary Care Network,” Journal of the Pediatric Infectious Diseases Society 4, no. 4 (2015): 297-304.