With all we know about antibiotic resistance these days, you would think the use of these drugs would be more closely monitored.
Well, a May 2024 study indicates otherwise. The researchers tracked more than 152 million visits to emergency rooms that resulted in one or more antibiotic prescriptions and compared them against diagnosis codes.
Their analysis revealed that 54% of the visits resulted in inappropriate antibiotic prescribing with a plausible antibiotic indication, while 46% resulted in inappropriate prescribing without a plausible indication.
To put this in perspective, bronchitis is a plausible, but inappropriate indication for antibiotics. That’s because bronchitis is generally a viral infection. Still, if your doctor believes a bacterial infection is contributing to your bronchitis – or if you are at high risk of bacterial infections – you may be prescribed one. But it should never be the first line of defense.
Other health conditions, such as hypertension or diabetes, are just downright inappropriate for antibiotic use. They aren’t even plausible.
Keep in mind that this study was based on emergency room visits. It doesn’t even account for inappropriate antibiotic prescribing in the actual hospital setting. Nor does it account for outpatient care or visits to your doctor’s office.
Many mainstream physicians are quick to write you up a prescription for an antibiotic when you have a cold or flu – even though antibiotics do nothing to stop or cure these viral infections. Still, about two out of every three doctors are still prescribing them for respiratory viruses.
And more than half of the time they’re prescribing the strongest kind of antibiotics available. These are called broad-spectrum antibiotics, capable of killing multiple kinds of bacteria all at once, including the good kind.
So that’s a problem.
The Link Between IBD and Antibiotics in Aging Adults
Recent studies show that antibiotic use in people over 40 is linked to a 48% increased risk of inflammatory bowel disease (IBD), on average. In fact, irritable bowel conditions like ulcerative colitis and Crohn’s disease are growing more rapidly in aging adults than others.
The risk is highest in the first few years following antibiotic use, and increases with each subsequent course of antibiotics.
Now here’s the thing. At the 32nd European Congress of Clinical Microbiology & Infectious Diseases, it was revealed that approximately three-quarters of antibiotics prescribed to patients over the age of 60 are considered improper.
That’s just crazy! It means that 75% of antibiotics prescribed to older patients are completely unnecessary.
The worst part is that seniors are more likely to receive repeated courses of antibiotics, and are sometimes prescribed two or three different antibiotics at the same time. So these elders are at the greatest risk of IBD.
In the past, we’ve always believed this heightened risk was solely associated with the severe imbalance antibiotics cause in the gut microbiome. But it goes well beyond that.
Just this month a new study came out that describes how antibiotics disturb the mucus barrier of the colon. This allows bacteria from waste material in the colon to enter the wall of the gut. It’s no surprise that this creates an inflammatory response. And it may be why so many people taking antibiotics end up with IBD!
Be Smart about Antibiotic Use
I would never recommend avoiding antibiotics altogether. They are one of the greatest breakthroughs in medical history. They save lives.
But mainstream doctors will almost always give you the strongest one possible, even if it’s for something like a urinary tract infection.
All that does is damage the mucus barrier of your colon and disrupt your gut microbiota even further. Not only does this increase your risk of IBD, it also opens you up to antibiotic-resistant infections in your retirement (glory!) years.
Always keep in mind that antibiotics don’t work against colds, flu, most sore throats, bronchitis, and many sinus and ear infections. So please, don’t demand one if you’re told it is not necessary.
If you absolutely have to take one, ask your doctor for an older, narrow-spectrum antibiotic that targets your specific problem. While it will still affect your gut microbiota, the results may not be as severe. Plus, because these antibiotics target very specific bacteria, they don’t really contribute to drug resistance.
Also, even though antibiotics kill both good and bad bacteria, taking a probiotic can help reduce the negative side effects. For example, if you take a probiotic while on antibiotics, you can cut your risk of developing a nasty antibiotic-associated C. difficile infection by about two thirds.
Look for one that contains multiple strains of lactobacillus and bifobacterium. The more strains and the higher the colony count, the better off you will be.
SOURCES:
Ladines-Lim JB, Fischer MA, Linder JA, Chua KP. Appropriateness of Antibiotic Prescribing in US Emergency Department Visits, 2016-2021. Antimicrob Steward Healthc Epidemiol. 2024 May 14;4(1):e79.
Disparities in Antibiotic Prescriptions in the USA. Review of the 32nd European Congress of Clinical Microbiology and Infectious Diseases (ECCMID). EMJ. June 2022.
Sawaed J, Zelik L, Levin Y, Feeney R, Naama M, Gordon A, Zigdon M, Rubin E, Telpaz S, Modilevsky S, Ben-Simon S, Awad A, Harshuk-Shabso S, Nuriel-Ohayon M, Werbner M, Schroeder BO, Erez A, Bel S. Antibiotics damage the colonic mucus barrier in a microbiota-independent manner. Sci Adv. 2024 Sep 13;10(37):eadp4119.
Faye AS, Allin KH, Iversen AT, Agrawal M, Faith J, Colombel JF, Jess T. Antibiotic use as a risk factor for inflammatory bowel disease across the ages: a population-based cohort study. Gut. 2023 Apr;72(4):663-670.
