Could antibiotics compromise my child’s gut bacteria?

One of the most exciting recent discoveries in medicine is the impact of microscopic organisms and bacteria on the state of a person's health. The concept of having a group of organisms in our bodies that influences our well-being in a symbiotic sort of way is an intriguing way to think about life. We have always known that we live in concert with other organisms, the food chain is a larger example of this. Now on a smaller scale, we live amongst smaller microorganisms which on one hand can causes disease, but in a different environment may also help our bodies stay healthy.

The microorganisms are not limited to the gut. There are bacteria and other organisms that live on our skin, in our respiratory passages, and basically wherever the body has an interface with the outside world. Our immune systems are very active in these areas of the body – dealing with various pathogens that can cause disease and appropriately not responding to harmless aspects in our environment.

Places like the gut are like a busy factory where things are highly regulated, but where so many things can go wrong. This makes the relationship between microorganisms in the gut and our immune system incredibly complex, and we are just touching the surface of the science behind these interactions.

A study that was published in Nature Communications earlier this year on the effect of a certain class of antibiotics called macrolides on normal gut bacterial populations is interesting and intriguing. The study suggests that in a small group of children treated with antibiotics, the risks of asthma and obesity were higher in the macrolide treated group when compared to the penicillin treated group. It should be noted that the number of patients available in the study group that were appropriate for this analysis was very small.

Moreover, in the overall patient selection exercise, it is not clear how the authors dealt with children who were exposed to both types of antibiotics at different times. Clearly, larger studies are needed to confirm their findings. But what the study does do is generate questions related to the effect of antibiotics on various health conditions.

Perhaps this study will stimulate more research that will help us identify good, better, and best antibiotics for specific patient populations and specific diseases. And of course, further studies will help us understand better how the immune system and the gut or respiratory tract microorganisms interact in normal health and in disease. What is even more exciting is that this study demonstrates that we have the tools to do these types of experiments, as the authors used databases of antibiotic purchases and DNA sequencing of fecal samples to generate tons of data that could be analyzed by computers to provide laboratory results, which can hopefully be translated to meaningful patient care.

We have long been concerned with the overuse or abuse of antibiotics to treat viral infections, and what this does to our bodies. We have also been worried about exposure to meat that contains antibiotics, though we don't always know what the antibiotic is. Unfortunately, in the United States, we have probably swung too far the other way, and we often don't use antibiotics even when they are in fact indicated. After all, antibiotics do have a role in preserving good health and have saved millions of lives. They shouldn't always be perceived as the "bad guy," we just need to know how to select the appropriate one and use them when clinically indicated.

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