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Antibiotics Are 'avoidable Trigger' For Bowel Disease
Scientists at The University of Manchester have shown for the first time how antibiotics can predispose the gut to avoidable infections that trigger bowel disease in mice.
The team, led by Dr Elizabeth Mann, also showed that substances derived from fibre prevent this damage to the gut, suggesting a high fibre diet could be useful when taken during and after a course of antibiotics.
The research is to be published in Science Translational Medicine and funded by the Wellcome Trust and the Medical Research Council.
They tested broad spectrum antibiotics on mice to assess their impact on the gut's microbiota, the community of microbes that live in the gastrointestinal tract.
After a week long course of antibiotics, a harmful immune reaction started that lasted at least 2 months, an equivalent, say the researchers, of many years in humans.
The immune reaction meant that significantly fewer beneficial bacteria which make 'short chain fatty acids', which are good for the gut, grew back.
However, short chain fatty acids, produced by the fermentation of dietary fibre by the microorganisms which live in the gut, could prevent the harmful immune response.
"Epidemiological evidence already links antibiotics given to babies and young children, when the immune system is still developing, to inflammatory bowel disease, asthma, psoriasis and other inflammatory diseases later in life," said Dr Mann, who is based at the University's newly launched Lydia Becker Institute of Immunology and Inflammation.
She said: "However, until now it has been hard to determine cause and effect, especially with the time lag between taking the antibiotics and the development of disease later in life.
"This study helps explain the link through understanding the biological processes involved.
"Inflammatory bowel disease in particular has multiple causes but one of the triggering factors in many people has been infections such as Salmonella or E coli.
"We show that after antibiotics, mice are more susceptible to these types of infections, and do not mount the proper immune response to clear the infection."
The gut is the largest source of bacteria in the body, where trillions of harmless bacteria critical for maintaining a healthy immune system live.
However, when antibiotics are taken orally, they deplete a massive community of bacteria in the intestines.
She added: "Not all patients taking antibiotics will get these diseases, and that's because most people need a genetic predisposition to get them.
"And it's very important that patients continue their antibiotics as these drugs are critical in clearing bacterial infections that can persist and cause serious health problems if left untreated.
"But what we're saying is that antibiotics must only prescribed when absolutely needed for bacterial infections.
"Antibiotics, for example, are useless against viral infections such as those that cause the common cold, flu and many chest infections."
The Impact Antibiotics Have On Your Gut Health
How does antibiotics impact gut health? (Getty Images)
Tis the season of illness, which for many could involve a trip to the doctors and a course of antibiotics.
While antibiotic use in England declined from 2014 to 2020, with large falls in 2020 related to the pandemic, latest data now shows a reversal in this downward trend, with antibiotic use in all settings (apart from dental) increasing in 2022.
And the festive period with its busy-ness, lack of sleep and opportunities to mix indoors can bring with it a dose of sickness, some of which could require the taking of antibiotics.
While antibiotics are sometimes necessary to treat a bacterial infection, in a bid to kill harmful bacteria they can also damage the beneficial bacteria that live in the gut.
"There's still a lot of research ongoing in this area," explains GP Dr Nazreen Morley. "However, essentially what happens is that while the antibiotics are killing off the harmful bacteria causing your infection, they can also kill off some of the 'friendly' bacteria that the gut requires."
There are a number of factors which could impact the effects of antibiotics on gut health including:
the type of antibiotic taken
the length of the antibiotic course
how many previous courses of antibiotics have been taken
gut health before taking the antibiotics
The age of the person taking the antibiotics can also play a role in the impact on gut health.
A recent Danish study, published in the journal Nature, found that the effects of antibiotic treatments on the gut microbiome last longer in adults than in infants, and different antibiotics are associated with distinct impacts.
Taking antibiotics can lead to gut-related illnesses. (Getty Images)
3 ways antibiotics can impact gut healthGut related illnesses
A 2020 study of previous research found that antibiotic use reduces overall gut flora diversity and disrupts the balance between species.
"Antibiotic use can have several negative effects on the gut microbiota, including reduced species diversity, altered metabolic activity, and the selection of antibiotic-resistant organisms, which in turn can lead to antibiotic-associated diarrhoea and recurrent Clostridioides difficile (C.Diff) infections," study authors explain.
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C. Diff is a harmful type of bacteria that lives in the intestines and while other microbes can keep C. Diff under control, taking antibiotics can allow the bacterium to grow, which can lead to diarrhoea.
A 2017 review reports that even a short course of antibiotics may disrupt the gut microbiome for up to one year or more afterward.
Antibiotic resistance
Studies have shown antibiotic treatments could lead to antibiotic resistance.
New research, lead by Imperial College London scientists, has found that antibiotic-resistant bacteria get extra nutrients and thrive when the drugs kill 'good' bacteria in the gut.
Professor Rob Galloway, consultant in emergency medicine based in Brighton is worried about the rise in antibiotic resistance.
"The risks of antibiotic resistance is real and growing," he tells Yahoo Life. "There is a risk that what was once routine cancer treatments or operations could be a distant memory because the infections which so often follow these treatments will no longer be so easily treatable."
Digestive health
Taking antibiotics could also impact digestion with a previous study of Danish children reporting that the likelihood of developing inflammatory bowel diseases (IBD) was highest in the first three months after taking antibiotics.
Turns out the risk was highest in children who had received at least seven courses of antibiotics.
There are many ways to help protect your gut health while taking antibiotics. (Getty Images)
Protecting gut health while taking antibioticsThankfully there are some practical steps people can take to protect their gut health while taking a course of antibiotics.
Taking probiotics"Studies have shown that taking probiotics can help to minimise the negative effect that antibiotics by partially restoring gut flora," explains Dr Morley.
According to the Health and Food Supplements Information Service (HSIS) probiotics interact with the rest of the gastrointestinal system to inhibit the growth of harmful bacteria by:
Speeding up gastrointestinal transit and reducing the ability of bad bacteria to proliferate and attach themselves to the gut lining causing potential health and wellness issues
Increasing production of bioactive metabolites (for example, short-chain essential fatty acids), which makes the pH in the colon more acidic and repels pathogens from taking hold
Making vitamins in the gut, improving absorption of minerals, supporting bile salt metabolism and enzyme activity, and neutralising toxins
Assisting communication between cells
Improving the gut barrier function to keep pathogens out of the sterile parts of the body
Reducing production of pro-inflammatory compounds that drive inflammation
Improving immune function.
However, the type and dose of probiotics are important.
A 2021 study found that a combination of Lactobacillus rhamnosus and Saccharomyces boulardii were effective, but further research is necessary to confirm this.
It is also worth noting that taking probiotics isn't without risk so it is advisable to seek medical advice about the pros and cons before taking them.
Eating a balanced diet can help boost gut health. (Getty Images)
PrebioticsThe HSIS defines prebiotic as "a substrate that is selectively used by host microorganisms conferring a health benefit." Put simply, they are foods for the strains of gut bacteria that we want to encourage, in the form of carbohydrates, fermentable dietary fibre, or some types of polyphenols and unsaturated fatty acids.
A 2015 study found that a high fibre diet and prebiotics can help stimulate the growth of Bifidobacterium - a group of bacteria that normally live in your intestines and stomach and help your body perform essential functions such as digestion and staving off harmful bacteria.
Maintaining good gut health
Keeping your gut healthy will help to ensure that, even if you do require antibiotics, you've the best chance of minimising any impact on the gut.
"A high fibre diet with plenty fruit and vegetables, a balance of required vitamins and minerals and staying well hydrated will all help," Dr Morley adds.
Professor Galloway also advises avoiding processed foods because they can also interact with the changes in gut flora after taking antibiotics and lead to the proliferation of bad bacteria which affects gut health.
Gut health: Read moreWatch: Survey reveals wellness-related goals for 2024What To Know About Antibiotics
Antibiotics work by killing bacteria and preventing them from multiplying. Common antibiotics include gentamicin, cephalexin, ertapenem, erythromycin, ciprofloxacin, and metronidazole.
They include a range of powerful drugs used to treat diseases caused by bacteria.
Antibiotics cannot treat viral infections, such as cold, flu, and most coughs.
This article explains what antibiotics are, how they work, potential side effects, and antibiotic resistance.
Antibiotics are powerful medications that treat certain infections and can save lives when used properly. They either stop bacteria from reproducing or destroy them.
Before bacteria can multiply and cause symptoms, the immune system can typically kill them. White blood cells (WBCs) attack harmful bacteria — even if symptoms occur, the immune system can usually cope and fend off the infection.
However, sometimes the number of harmful bacteria is excessive, and the immune system cannot clear them all. Antibiotics are useful in this scenario.
The first antibiotic was penicillin. Penicillin-based antibiotics, such as ampicillin, amoxicillin, and penicillin G, are still available to treat a variety of infections and have been in use for many years.
Several types of modern antibiotics are available, and they are usually only available with a prescription in the United States. Topical antibiotics are available in over-the-counter (OTC) creams and ointments.
There are different types of antibiotics, which work in their unique way. However, the two main they work include:
It may take a few hours or days after taking the first dose before people feel better or their symptoms improve.
There are various classes or groups of antibiotics, which depend on their chemical structure. Some classes of antibiotics include the following:
This list is not inclusive — other classes and brand names exist. In addition, penicillins, cephalosporins, and other antibiotics may be regarded as subclasses of beta-lactam drugs.
Experts advise using antibiotics only when they are needed. This is to ensure that the bacteria is killed and is unable to multiply and spread to other parts of the body.
Also, antibiotic use can sometimes be associated with side effects and antibiotic resistance.
Antibiotic resistance occurs when germs no longer respond to the antibiotic designed to kill them. Inappropriate prescription of antibiotics is driving up the incidence of antibiotic resistance.
Sometimes prescriptions of the wrong medication — or the wrong dosage — can lead to antibiotic misuse. Misuse can also occur when people do not take antibiotics as their doctor prescribes. Some measures people can take include finishing the treatment course and not sharing antibiotic medications with others— even if they have the same symptoms.
The Centers for Disease Control and Prevention (CDC) state that in the United States, around 47 million antibiotic courses are inappropriately prescribed to people, meaning their illness did not require antibiotics.
Some bacteria — such as Enterobacterales — can become resistant to carbapenems, a major class of last-line antibiotics. Enterobacterales are an order of bacteria that can cause pneumonia, meningitis, and other diseases. Escherichia coli (E.Coli) is an example of an Enterobacterale.
CRE, or carbapenem-resistant Enterobacterales, pose a major concern to people in hospitals and other healthcare settings.
Experts believe that carbapenem resistance may lead to:
In his Nobel Prize acceptance speech in 1945, Alexander Fleming said:
"Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug, make them resistant."
As the man who discovered the first antibiotic predicted, drug resistance is starting to become commonplace.
Antibiotic resistance is now considered one of the greatest public health challenges.
A doctor prescribes antibiotics for the treatment of a bacterial infection. It is not effective against viruses.
Knowing whether an infection is bacterial or viral helps to treat it effectively.
Viruses cause most upper respiratory tract infections, such as the common cold and flu. Antibiotics do not work against these viruses.
If people overuse antibiotics or use them incorrectly, the bacteria might become resistant. This means that the antibiotic becomes less effective against that type of bacterium, as the bacterium has been able to improve its defenses.
A doctor can prescribe a broad-spectrum antibiotic to treat a wide range of infections. A narrow-spectrum antibiotic is only effective against a few types of bacteria.
Some antibiotics attack aerobic bacteria, while others work against anaerobic bacteria. Aerobic bacteria need oxygen, and anaerobic bacteria do not.
In some cases, a healthcare professional may provide antibiotics to prevent — rather than treat — infection, as might be the case before surgery. This is the "prophylactic" use of antibiotics. People commonly use these antibiotics before bowel and orthopedic surgery.
Learn more about aerobic and anaerobic bacteria.
Antibiotics commonly cause the following side effects:
Some unusual side effects of antibiotics include:
Some people — especially older adults — may develop C.Difficile infection. They may experience bowel inflammation, which can lead to severe, bloody diarrhea.
Learn more about the side effects of antibiotics.
Some people may develop an allergic reaction to antibiotics, especially penicillin. Side effects might include:
Allergic reactions to antibiotics might be immediate or delayed. This means that a person may experience adverse effects of the drug within an hour or within weeks.
Anyone who has an allergic reaction to an antibiotic must tell their doctor or pharmacist. While rare, people may experience a serious and sometimes fatal reaction to an antibiotic. They are called anaphylactic reactions.
People with reduced liver or kidney function should be cautious when using antibiotics. This may affect the types of antibiotics they can use or the dose they receive.
Likewise, people who are pregnant or nursing should speak with a doctor about the best antibiotics to take.
Learn more about penicillin allergy.
Individuals taking an antibiotic should not take other medicines or herbal remedies without speaking with a doctor first. Certain OTC medicines might also interact with antibiotics.
Some doctors suggest that antibiotics can reduce the effectiveness of oral contraceptives. However, research does not generally support this.
Nonetheless, people who experience diarrhea and vomiting or are not taking their oral contraceptive during illness due to an upset stomach might find that its effectiveness reduces.
In these circumstances, doctors may recommend people take additional contraceptive precautions.
Doctors may also advise avoiding alcohol for certain drugs, such as doxycycline. However, drinking alcohol in moderation is unlikely to cause problems with the most commonly used antibiotics.
Learn more about avoiding alcohol for certain drugs.
People usually take antibiotics by mouth. However, doctors can administer them by injection or apply them directly to the part of the body with infection.
Most antibiotics can start working within a few hours. Doctors advise people to complete the whole course of medication to prevent the return of the infection.
Stopping the medication before the course has finished increases the risk that the bacteria will become resistant to future treatments. The ones that survive will have had some exposure to the antibiotic and may consequently develop resistance to it.
An individual needs to complete the course of antibiotic treatment even after they notice an improvement in symptoms.
Doctors and the leaflet provided with the drug provide specific instructions on how to take the medication correctly.
People can follow some tips for using antibiotics effectively, such as:
Here are some frequently asked questions about antibiotics.
What are the 10 most common antibiotics?Here are ten examples of common antibiotic types:
How quickly antibiotics work can differ for each individual, and may depend on the type and severity of infection. A typical course of antibiotics lasts between 5 and 14 days.
What should a person avoid while on antibiotics?A person will typically need to avoid drinking alcohol when taking antibiotics. Some medications, such as the contraceptive pill, may also interact with antibiotics. A person's doctor can advise on what a person should avoid during antibiotic treatment.
What happens if you take antibiotics too close together?If a person takes two doses of antibiotics too close together, there may be an increased risk of side effects. These can include symptoms such as diarrhea and stomach pain. Following the instructions on the prescription can help to reduce the risk of side effects in some people.
Is it bad to take antibiotics a few times a year?A person should only take antibiotics when they need them and when their doctor prescribes them. If a person needs to take antibiotics regularly, their doctor may look at other treatment options or take steps to identify what is causing frequent infections.
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