Antibiotic Prophylaxis: All You Need to Know
In his book, professor of genetic epidemiology Tim Spector actively warns against the thoughtless use of antibiotics and writes about the strong potential harm of antibiotic prophylaxis to the human microbiome and talks about other risks, including death. However, Spector specializes in the study of the microbiome, and his position can be overly cautious.
When antibiotics help, and when they harm? Let’s investigate together!
What are Antibiotics?
Antibiotics are medicines used to treat bacterial infections. What is important, they act on bacteria and not, for example, viruses. The mechanism of action of antibiotics is associated with the fact that they either disrupt the reproduction of bacteria (such drugs are called bacteriostatic) or completely lead to their destruction (bactericidal antibiotics). The main thing to understand is that antibiotics are drugs that target only bacteria and some types of protozoa, not all types of microbes.
Different classes of antibiotics are effective against infections caused by bacteria or protozoa. Contrary to popular misconception, antibacterial drugs will not act on diseases caused by viruses – in this case, they are completely useless and even harmful.
This photo shows a test for the sensitivity of bacteria to various antibiotics. Discs soaked in various antibiotics are placed on the surface of the Petri dish, on which bacteria grow. The transparent area around the disc – the growth of bacteria is suppressed by the action of the antibiotic.
Probiotics Along with Antibiotics
It is important to remember that when an antibiotic is prescribed against any infectious agent, it will, unfortunately, act not only on conditionally harmful microorganisms but also on conditionally good ones. But the appointment of probiotics together with an antimicrobial drug will not save and will not protect good microorganisms.
It is not necessary to immediately prescribe probiotics along with antibacterial drugs. First of all, it is impossible to know in advance which microorganisms deficiency will occur when using antibacterial drugs. Some probiotics contain microorganisms that carry the gene for resistance to antibacterial drugs.
In addition, probiotics generally do not have a large evidence base. In evidence-based medicine, there is no such diagnosis as “dysbiosis.”
Antibiotic Restrictions. Why Not Turn to Antibiotic Prophylaxis
The most important thing to say about antibiotic prophylaxis is that you cannot take antibiotics when there is no indication, for example, with a viral infection.
Antibiotics also do not cure fever – they are not antipyretic, and fever in itself is not a reason to prescribe antibiotics since it can be caused by many reasons.
Only a doctor can understand whether there are indications for the use of antibiotics or not. Therefore, they must be taken strictly according to the doctor’s prescription.
And, of course, it is undesirable to use any drug with alcohol.
Science about Antibiotic Prophylaxis
Prevention with antibacterial drugs is possible in surgery: the generally accepted standard is that an antibacterial drug is injected half an hour before the skin incision to prevent the development of infection in the area of the operation.
In other cases, antibiotic prophylaxis is a useless occupation, only harmful, since it leads to the development of adverse side effects, for example, antibiotic-associated diarrhea, which can even be fatal.
If an antibiotic is prescribed not according to indications, taking it can, among other things, lead to antimicrobial resistance (AMR) – the resistance of microorganisms to antibacterial drugs.
About Antibiotic Resistance
Antimicrobial resistance (AMR) – the resistance that microbes acquire to antibacterial drugs when they stop responding to proven, previously effective treatments – puts the patient’s health and life at significant risk. This is a big global problem, as there are fewer and fewer antibacterial drugs that are effective against such resistant microorganisms.
The main reasons for the development of AMR are unreasonable, not according to indications, the use of antibacterial drugs and long-term (when the patient has already been cured of the infection by all markers, but the doctor proposes to extend the admission for several days for prevention) or too short course (did not complete the treatment and quit) of drugs use.
Short courses are also dangerous because, in a few days of treatment, the microbes do not die at all, but they already have time to interact with antibacterial drugs and multiply – this is how microbes appear that are resistant to this antibiotic, and they will continue to multiply and transmit the resistance gene further.
Antibiotics: Injections or Pills – What’s the Difference
This is especially important in the case when the patient is in a hospital in critical condition, when it is necessary to quickly create a high concentration of antibiotic in the blood, for example, in severe septic shock – then the intravenous form of administration is preferable. This is due to how much the drug can be absorbed into the bloodstream and how much it will enter the systemic circulation.
Intravenous administration of antibiotics is the priority of a serious patient who is in the intensive care unit, has a severe bacterial infection, and is in a state of septic shock. Patients in a state of moderate and mild severity, including those in outpatient treatment, can be perfectly treated with tablet forms of antibiotics – there are a fairly large number of drugs in the form of tablets, which are also well absorbed and create a high concentration of the substance in the blood.
One of the conditions when intravenous administration of antibiotics is preferable, is when the patient has impaired swallowing and simply cannot swallow the pill. For example, if the patient has a stroke, and against the background of this has developed an infection, for example, nosocomial pneumonia, then it is possible to use the intravenous form.
Antibiotics for Children
Antibiotics are no more dangerous for children than for adults. Again, if an antibiotic is prescribed according to indications, it will not only not be dangerous for the child but, on the contrary, can save their life. Unfortunately, in pediatrics, they like to play it safe, and antibacterial drugs are often prescribed for catarrhal viral phenomena – a runny nose and cough, which cannot be done. First of all, you can get an allergic reaction. In addition, the unjustified prescription of the drug leads to the risk of developing resistance and antibiotic-associated colitis.
It is important to remind that the instructions for medicines, including antibiotics, must be read by both doctors and the patients themselves and the parents of young patients. The instructions always indicate when you need to take an antibiotic, what it can be combined with, including with what food – some antibacterial drugs, when taken together with food, lose their activity, while others, on the contrary, need to be washed down or seized with something to increase their absorption.
It is important not to hesitate to ask your doctor questions – you have every right to ask why they prescribed an antibiotic, for what purpose, what infection needs to be cured, in order to know for sure that there is a real reason for such a prescription.
Will antibiotics stop being effective as resistance grows? Antibiotic prophylaxis results
Hopefully, this does not happen. Let’s hope that antibacterial drugs will be more deliberately prescribed, global resistance will be contained, and there will not be a time when we cannot prescribe a single drug to defeat germs.
To combat the AMR problem, it is also necessary to inform the population about when antibiotics are not needed (as in viral infections or fever), that antibiotic prophylaxis does not make sense.
Measures are also needed inside hospitals – for example, restrictions are already being introduced: in order to prescribe a certain drug, the doctor must go through some algorithm to confirm that the patient really has any bacterial infection and needs an antibacterial drug corresponding to the level of infection in order to exclude accidental and unreasonable prescription of an antibiotic.
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