Did you know that:

  • Antibiotic abuse in the United States is widespread. We have only 4.6% of the global population but we have 46% of the global antibiotic market?
  • 95% of clinicians prescribe antibiotics even when they are not absolutely sure they are needed?
  • 1 in 10 doctors will write a prescription for an antibiotic even though they know it’s not needed, just because a patient asks for it?
  • At least 10% of doctors think that it doesn’t matter if antibiotics are given unnecessarily because they don’t cause any harm?
  • Almost half of all doctors don’t counsel their patients against unnecessary antibiotic use?

Yet MOST of the antibiotics we are being prescribed by our doctors are unnecessary and even harmful!

Antibiotics, Microbiome Damage, and Your Health

We’re hearing a lot about the importance of the microbiome these days – and we’re going to continue to hear more as research into this fascinating intersection between our lives and the world of the microorganisms that live in, on, and around us evolves. What we do know already is that healthy communities of flora in our gut help regulate everything from our weight, mood and mental health to our immunity and hormones. A healthy micobiome contributes to how many calories we extract from our food – with too little of the good kind predisposing us to being fatter – and determines how well we detoxify excess hormones we produce due to dietary imbalances or that we pick up from environmental exposures.

One of the most certain ways to do damage to your gut flora, and along with it your health, is take antibiotics. Of course, an antibiotic is occasionally necessary and even life saving, but the hard truth is that most often they are unnecessary and even inappropriately prescribed.

In my Functional Medicine practice so many of the patients I see with chronic health problems, and especially digestive, allergy, hormonal, and autoimmune problems, share the common denominator of having had a lot of antibiotics as babies, children, or young adults – the former usually for ear infections, supposed strep throat, and bronchitis, and as young adults for acne – sometimes for years at a time.

We know that damage to the gut flora from early exposure to antibiotics – or frequent exposure at any time – can permanently damage the microbiome. There is strong evidence showing that even a single course of antibiotics in the first year of life increases our risk of developing gut problems and autoimmune conditions including Ulcerative Colitis and Crohn’s Disease, to name just a very few. Leaky gut, a common reason for most food intolerances and many inflammatory health conditions, including autoimmune disease, can also be triggered by damage to the microbiome as a result of antibiotics.

Antibiotic Resistance: What’s the Big Deal?

Antibiotic misuse is a problem for more than just to our gut flora. We are experiencing a major global health crisis due to antibiotic resistance — the antibiotics we rely on for serious and life-threatening diseases no longer work because we’ve used them so much that the bugs we are treating have outsmarted us and can withstand exposure to them. We now have antibiotic resistant super bugs and increasingly, no effective treatments for many of them! At least 2 million people get infected with antibiotic-resistant bacteria each year, resulting in at least 23,000 deaths, according to the Centers for Disease Control and Prevention (CDC).

There are also immediate risks to taking antibiotics. They can cause allergic reactions, additional antibiotic resistant infections on top of whatever you are being treated for, and can cause a deadly diarrhea caused by the bacteria Clostridium difficile. Many antibiotics can cause additional serious consequences ranging from rupture of the tendons with common medications like ciprofloxacin used to treat urinary tract infections, to fatal cardiac arrhythmias. We take them like they are no big deal – but they really are!

Further, pharmaceutical companies are no longer developing new antibiotics because they “can’t break even.” The last new antibiotic class for gram-negative bacteria was the quinolones, developed 4 decades ago.

The Scary Myth of the Harmless Antibiotic & Why Doctors Over-prescribe Antibiotics

There are many common reasons that doctors over-prescribe antibiotics, the most common being feeling uncomfortable not treating a possible bacterial infection (in other words, the fear of being wrong if they didn’t treat and it turned out the patient did have one), fear of malpractice, the patient requesting an antibiotic, and additionally, the patient not being able to miss work.

Is Your Doctor an Antibiotic Over Prescriber?

Chances are that the answer is yes, your doctor is an antibiotic over prescriber, because most are. A study done looking at records from the Veteran Affairs (VA) system between 2005 and 2012 found that on more than 1 million visits to primary care, urgent care, and emergency room settings for upper respiratory infections, most of which are viral and never require antibiotic  treatment, antibiotics were prescribed almost 70% of the time, and this number was trending upward. Perhaps the most concerning issue is that in studies of antibiotic use it has been found that over 10% of doctors surveyed believe that it doesn’t really matter if they over prescribed, because the antibiotic wouldn’t hurt even if it wasn’t needed.

Antibiotic Stewardship: 6 Ways to Avoid Unnecessary Antibiotics

Stewardship means the activity or job of protecting and being responsible for something. Since it’s pretty clear that most doctors feel comfortable giving out antibiotics like candy, and aren’t going to tell us when they really aren’t needed, we have to take personal responsibility for avoiding unnecessary antibiotics treatment. Taking personal responsibility can also have an impact on ecological health and global antibiotic resistance. Antibiotic stewardship specifically refers to coordinated efforts to improve the appropriate use of antibiotics. Reading this article is your first step!

Read on for the next steps in avoiding antibiotic overuse and misuse.

1. Express Your Preference to Avoid Antibiotics

If you don’t want to be prescribed an antibiotic, let your doctor know. She or he may be prescribing one under the false impression that it’s what you want or expect. She or he may also feel so busy and harried that it’s just easier and faster to write an antibiotic prescription than to have a conversation with you about why an antibiotic isn’t necessary. So make your preferences known loud and clear. If the medical condition requires an antibiotic, then your doctor should respectfully let you know that this is the case and explain why. Then you can discuss what is safest and most appropriate for you. If it is unclear whether an antibiotic is truly needed, but there is a high suspicion that you have a bacterial infection, ask your doctor to check your procalcitonin level, a biomarker for infection. This test has been shown to be successful in nearly every well-controlled trial.

2. Ask Questions

If an antibiotic has been prescribed and yet it’s not your preference to take one, ask your doctor how important it is for you to start taking it immediately, or whether a “watch and wait” observation period is appropriate, ask how long you can watch and wait for, and what you should look out for as signs of improvement or of things getting worse, and how long it should take for you to get better. Also, ask if there are any alternatives – for example, there may be nutritional or herbal supplements that you can try instead of the antibiotics. If an antibiotic is deemed to be necessary, ask your doctor about doing a short course, for example, 3-5 days instead of 10-14 days. Short courses of antibiotics are virtually always effective in well-controlled trials.

3. Get Smart!

Get educated about the common health conditions that would bring you to the doctor for yourself or one of your kids and for which antibiotics are commonly misused, including ear infections, bronchitis, and even strep throat, so you can make wise and optimally healthful decisions. A great resource is called Get Smart, created by the Centers for Disease Control and Prevention (CDC) exactly for the purpose of helping you – and your doctors – avoid unnecessary antibiotics. You can refer to this site before you visit the doctor’s office and even bring information with you to help you avoid unnecessary antibiotics, you can visit the site with your doctor who might not even know about it, and visiting the site may even help you avoid a premature or unnecessary doctor’s visit.

4. Trust Your Body and Make the Time to Heal

My great-grandmother always said rest was the most important thing we could do when we’re sick – including time for convalescence after an illness. Unfortunately, most of us were never taught the simple types of wisdom our grandmothers knew, and most of us don’t (or feel we can’t) take the time to get well – whether getting a few days help with the kids or taking a few days off of work. So we ask for antibiotics in hopes that our symptoms will clear up faster – and sometimes antibiotics can make this happen. But the problem is that if we take antibiotics to hasten healing now, we might pay the price with chronic problems later. When we get sick what we really need to do is eat simply and well, take some time for R&R, and get some extra rest. In short: Pay now in time or pay later in health.

5. Learn About Alternatives to Antibiotics

Simply by changing your diet (clue: drop the dairy, sugar, and flour products for a few days) and adding in a few natural supplements including vitamins, minerals, and herbs, you can reduce the symptoms, severity, and duration of most common viral and many bacterial infections without having to use antibiotics. Sometimes, even more complex acute and chronic infections respond well to natural remedies without having to use antibiotics – but this might require you to see an integrative MD, a licensed naturopathic doctor, or a skilled herbalist for suggestions. On my website you will find an ever-growing body of resources on the natural treatment of common infections and many other of your health concerns.

6. Eat Antibiotic-Free

80% of the antibiotic use in the United States is for growth promotion and disease prevention in farm animals – and these antibiotics make their way to us in what is know as the “farm to fork” phenomenon. Not only do antibiotics make their way to us, but so do resistant bacteria and bacterial resistance genes, which can be traced directly from chickens to the chicken meat in grocery stores to blood cultures in people. The practice of antibiotic use on farms was discontinued in some European countries many years ago, without economic or animal health consequences – and this is beginning to happen in our country as well. We can protect our health and the environment, and demand farming changes like this by voting with our dollars and purchasing only antibiotic-free meat.

If you really do need to use an antibiotic, it is not the end of the world, and it is important to be practical and open to the wonderful array of options both nature and science have to offer us for our health and well being. A healthy gut will usually repair itself perfectly if antibiotic use is rare or infrequent. The addition of fermented foods like sauerkraut, kimchee, and homemade yogurt (if you tolerate dairy, or if not, try coconut yogurt with live active cultures), as well as a probiotic and gentle gut healing herbs can also help restore your gut’s natural health and flora.

References

Bartlett JG, Gilbert D Spellberg B. Seven ways to preserve the miracle of antibiotics. Clin Infect Dis. 2013;56:1445-1450

Jones, BE et al. Variation in outpatient antibiotic prescribing for acute respiratory infections in the veteran population: A cross-sectional study. Ann Int Med. 2015. Jul 21; 163-73.

Schuetz P, Briel M, Christ-Crain M, et al. Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections: an individual patient analysis. Clin Infect Dis. 2012;55:651-662.

http://www.ewg.org/meateatersguide/superbugs/

 

 

16 Comments

  1. I have an additional reason that I am not quick to turn to antibiotics until I know my body needs the extra help. Over my lifetime, I have become allergic to three different classes of antibiotics (penicillin, sulfa and quinolone). On top of not wishing to develop resistant bacteria, I don’t want to risk developing a new allergy by unnecessarily my system to a medication it doesn’t need.

  2. Thanks so much for the very informative article! As a young adult in my early 20s, I took antibiotics for almost 4 years for acne. At the time, I didn’t know better and just trusted the doctor telling me it would clear up my skin! It probably took the next 8 years to clear up all the allergies, food intolerances and hormonal imbalances from this overuse! Yikes! What a mess this creates in our systems. I do have a question for you. After many years of healing my system, I became pregnant naturally last fall, and we are expecting our first little one in 3 weeks! So exciting! I just did the GBS (Group B Strep) culture so I don’t have the results back yet. But it’s definitely something I have been thinking about as the midwife practice I am with really encourages the antibiotic route if you test postitive. I am torn about this decision (if I will need to make it) given my history with antibiotics! I haven’t taking any in 10 years and hate to start a little one off with a giant dose of penicillin to his or her system! But, of course, the consequences of GBS infection, while rare, are very severe. I have loved your other pregnancy specific articles so I was wondering if you have ever addressed this issue or if you would consider discussing it? Love your blog! Thanks so much for all the great information. Rose

  3. I have the same concerns about overuse of herbal antimicrobials but have yet to find any paper that discusses damage to commensurate bacteria. You haven’t come across any in your research have you?

    • Botanicals are much less likely to lead to resistance because they are complex structures and no single botanical is exactly like another, even when using the same herb. I have come across a very small amount of data suggesting that topical tea tree oil in hand sanitizers may lead to resistance.

  4. Fascinating article! I have read two complete books on overuse of antibiotics and yet this article contained new information to me. Thanks Aviva for another great resource!

  5. I was always taught that I couldn’t take a shorter course of prescribed antibiotics, due to the fear that the bacteria would become resistant. Can you explain?
    Thanks

    • Data now shows that many antibiotics can be used for shorter courses just as effectively with less likelihood of building resistance. But check with your prescribing doctor because this changes with condition and medication…

  6. I would like to add a seventh. Work on immunity and a healthy gut so as to avoid antibiotics. My son had to have antibiotics at the end of last summer due to a staph infection in his femur (osteomyelitis.) When he came off the antibiotics, he became a nightmare! He could no longer stay in his seat at school (first grade) and would race around the classroom seeming to be in fight or flight. We did do probiotics from the beginning, but I am now suspecting he had some gut issues already or the staph infection may not have been able to take hold. I am still working on repairing his gut, although he is much, much better. I have learned so much!

  7. I took my daughter to the doctor a few months ago because she had what I thought was a cold. I decided to take her because she seemed to be breathing a little fast. Since she was a (almost 5 year old )preemie, I am always concerned when she gets sick ( a mother’s thing I guess)
    The doctor checked her and said she was fine. Then he looked in her ears and said that an ear infection was starting. Of course he prescribed antibiotics. I went and got the antibiotics but never gave it to her. I had to admit that I had my fears and doubts when I decided not to giver her the antibiotics but went with what my heart told me to do. I somehow did not feel comfortable with the ” just starting ear infection”. She was fine the day after. Never complained of no pain or discomfort at all. I watched her for days in case she did show any symptoms. Nothing! Did I do right?

  8. It is not just gut flora that we need to protect! When good bacteria is wiped out there is an open ground for fungal/candida imbalance to develop. I am usually a person who avoids chosing antibiotics for our family, but during an aggressive bout of cellulitis in my face and ear, I was told at the hospital that there was no other choice. Now, 1 1/2 years later I am still struggling for balance with candida overgrowth in my ear. After this experience, I feel so much stronger in my belief that antibiotics should be reserved for the times that they are needed–if my infection had reached my brain, I may have died. But the frustration for me is the ignorance of being told there was nothing else I could do. I am sure that my recovery was so much more supported from the garlic, reishi, goldenseal, echinacea, honey, oregano, astragalus and elderberry that I took. I wish I had diligently taken probiotic just as aggressively. If only I had known more about ear health –in retrospect I would have refused the topical antibiotics in my ear canal and just taken the intravenous. The ear is dark and cavernous, add moisture and these are perfect fungal conditions once the antibiotics have cleared the slate. There are real health complications that can come from antibiotic use and the decision should not be made lightly or without being informed. Great article Aviva, I love the concept of antibiotic stewardship!
    I would love to see a piece from you regarding probiotics and prebiotics, there seem to many different opinions out there about the benefits or hazards of prebiotics, and the market is so flooded with probiotics…we need Aviva’s myth-busting to the rescue!

  9. Good morning,
    This blog could not have re-posted at a more appropriate time. My 23 month old daughter was recently prescribed an antibiotic for a UTI by an ED docotor. When I contacted my daughter’s pediatrician prior to dosing she said that antiobiotic would not have been her first option because it’s an older one. She also said my nose was very perceptive and grest catch on my part by noticing the change in smell of her urine. For me that’s just part of being an attentive mother. Her pediatrician said she would do some research on the drug and give me a call back in a few minutes. She called back and said the drug was okay because it was supposed to be just something used until the culture came back with the specific strain of bacteria, if any. I was uncomfortable with giving the antibiotic in the first place for many reasons. Nevertheless, I wanted my baby to not hurt anymore and be rid of the bacteria. We gave her the mediciation and within hours she was no longer complaining of pain, and the odor from the urine was gone. I watched her like a hawk for AE’s and SAE’s. She had a low fever for 30 mins after dosing and almost instant itching. I did not like that at all. But both subsided within 30 mins or so. I kept watching her day-by-day and I noticed her getting more and more tired. Saying to me “Mommy, I’m tired”, and sometimes asking to take a nap. The last straw was when she took two naps one day. Totally unusual for her. So after reading through the laundry list of side effects again for anything I may have missed and coming across many that were horribly frightening I took her off. She had 7 consecutive days of dosing, so I felt comfortable with stopping. Within 24 hrs complaint of the symptoms returned. I felt horrible for my baby. The drug didn’t work. Just for the record, my daughter has nursed since birth and is still nursing, eats an organic diet, does not drink dairy, and does not eat red meat or pork. She drinks plenty of clean water and does not eat sweets. So. her researching mama started looking for alternatives to antibiotic use for toddlers with UTIs. I found little info. But what I did see was your blog, and found the office of a highly regarded Integrative and Holisitc Medicine Center that specializes in Women’s Health and Pediatics.

  10. Thanks for spreading the word! I’m 23 and have struggled with debilitiating allergies, chronic sinusitis, and just plain poor health for most of my life. I’ve had round after round of antibiotics and even 3 sinus surgeries and nothing helped until I stopped accepting antibiotics and started treating things naturally. Natural health really has worked and it’s completely changed my outlook on health! It freaks some people out that I refuse antibiotics whenever I can but I’m not dead, in fact, I’m healthier! It’s been a long journey but things are finally getting better! Praise God!

  11. I have been caregiver for my 91 year old mother for the last year who was put in severe danger through use of opioid medications, and her recovery from that in a rehab center took three months. Four days after discharge, she had a stroke which was said to have been likely caused by endocarditis. Opiates depress natural killer cell activity, Loss of NK activity has been assoicated with developing endocarditis. The hospitalists put her on a month of penicillin for the endocarditits even though I asked them at the time if that protocol to keep her on it so long was evidence based, and they said no but she was trapped.

    At the time, I found in the literature an article talking about pencillin blocking carnitine transport competitively, but the hospitalists refused to give her carnitine, so the result of that month on penicillin was a profound carnitine deficiency and profound weakness, and greatly disturbed biochemistry as assessed by organic acid and amino acid testing we did when she was moved to another hospital. Medicare had trapped her and tied my hands, so it took four months for me actually to find a place that would test and TREAT her carnitine deficiency, and after that, she started to get better.

    But she got a UTI, and I found literature that said taking cranberry juice and methionine would work as well as antibiotics, and the doctor at that rehab center agreed to try that after reading the article, and that’s what we did, and it solved the problem quickly,

    She had to leave that place after running out of medicare days, and they had finally started to treat her carnitine deficiency but in the next institution she acquired a cold, and when they cultured her sputum, it came back with MRSA and psuedomonas, which are often picked up in instiutional settings occurring together. We got the doctor to agree to giving her monolauren, and an infectious disease doctor recommended Bacitracin in her nose, and on those two together with mitochondrial support her recovery was rapid.

    Before we did this, the infectious disease doctor had given me the list of antibiotics that both infections were sensitive to, and I looked up each one in the medical literature and out of about twenty antibiotics, only one did not have literature showing that it would damage the mitochondria, and I was horrified at that information. That’s why, and especially because my mother by the time of this decision was already over the cold we went for the topical antibiotic in her nose.

    She recovered so quickly that the nurse in the institution ran down the hall to catch me to say that in his career he had never seen soimeone recover so quickly. Then after that they dropped the CoQ10 and carnitine she had been on from the other institution, and she started going rapidly downhill again, We were not told they dropped the mitochondrial support.

    All this happened after I heard a lecture from a mitochodrial researcher who basically said that about 85% of our immunity involves our mitochondria, and what he said kept haunting me through my mother’s experience and noticing in nursing homes a profound morality built around constant antibiotic use and testing, but I didn’t see evidence that patients ever got truly well with that approach.

    Finally in a group home setting, and getting mitochondrial support, my mother is actually doing well now, and building strength. She can walk with a walker, but still needs assistance. She is doing well enough that she passed her swallow test and is starting to eat pureed food for practice after ten months of being on a feeding tube.

    I missed saying that at one place where she had been making improvements, they tested her with a UTI, and had her already scheduled her for a swallow test, and against my will, they started her on an antibiotic that affects muscle signal transmission, and she flunked the swallow test. That was no surprise being on that medication! That one choice cost my mother four more months of being on a feeding tube. If they had done like the institution she went to later which used cranberry juice and methionine to treat the UTI, she might have gotten off that feeding tube four months earlier!

    There is all sorts of literature showing antibiotics have other effects on the metabolism that are direct and not associated with their killing attributes. Physicians need to be taught this other side. I have known about it, because I do research and also have had many opportunities to study the wrecked metabolism that people acquire after long coiurses of antibiotics.

    When my mother just had her stroke, they started giving her medicines that in combination wrecked her biochemistry so badly that she ended up in ICU, It wasn’t even a bad stroke. She was “even” in strength even before she left the emergency room, but what they did after that metabolically weakened her so badly that it has taken a whole year to get her out of danger. I am, obviously, not a big fan of antibiotics and other over treatment of the elderly who cannot metabolize these complex biochemical interactions of drugs.

    In all this, we did also do genetic testing and learned that my mother cannot metabolize most drugs because of a genetic defect in glucuronidation. I’ve been told twice this last year, “In Western medicine, we don’t do genetics.”

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