We’re surrounded by bacteria– literally. They live on the surface our skin and set up camp in our intestines immediately after birth. The complexity of the colonies that live there diversifies throughout our lives–many sticking around for the duration. And we’re dependent on the ka-billions of bacteria that co-exist with us to maintain our health. Without them, things can go off-kilter as bacteria really are a part of our wellness–supporting digestion and maintaining harmony on our skin. Of course, some bacteria come in that we’d really rather not have. That’s when we use antibiotics.
As cough and cold season returns, a study published today serves up a needed reminder. Antibiotics can cause significant changes to our body. Because many infections are caused by viruses (not bacteria) antibiotics are often unnecessary. When we take antibiotics by mouth (or IV/injection) they may kill the bacteria causing a troubling or painful infection yes, but they can also kill the desired “good bacteria,” too. This is a side effect all antibiotics carry. Often we witness this in our children by changes in their poop—after a course of antibiotics they get really runny poop or diarrhea or it will smell entirely different. You really are witnessing the change of colonies in their intestines when you see this.
Sometimes antibiotics are absolutely necessary and life-saving. But recent research has found that antibiotics are prescribed in 1 out of 5 pediatric acute-care visits. And of the 49 million prescriptions for antibiotics given annually, some researchers estimate that 10 million of those are unnecessary. Avoiding those unnecessary courses is up to all of us–parents and clinicians.
I really do think the tide is changing in this regard. It’s rare that a family requests or urges for antibiotics in clinic.
New research is looking at how altering bacteria in our bodies may change our life-long health. It’s not just the alteration in our poop immediately after antibiotics that changes. A new study shows antibiotic use may set us up for chronic disease. And this may be especially true when antibiotics are used in infants and young children.
Research Finds Antibiotics May Be Associated With IBD Diagnosis
- Dr Matthew Kronman and colleagues studied over 1 million patient records in the UK. They evaluated the infant and childhood exposures to certain antibiotics and the later development of Inflammatory Bowel Disease (IBD). The causes of IBD are incompletely understood; Dr Kronman wanted to understand if bacterial changes in the intestines at young ages affected inflammation that could potentially increase the likelihood of being diagnosed with IBD (Crohn’s disease or Ulcerative Colitis). They studied medical charts of a huge group of patients to determine if children prescribed common oral antibiotics in outpatient clinics (penicillin, amoxicillin, Augmentin, clindamycin, metronidazole, for example) had increased rates of IBD later in life.
- They studied over 1 million patient charts. Of those 1M, 748 children developed inflammatory bowel disease.
- Infants given antibiotics had the highest increase in IBD risk: with each antibiotic course, a 6% increase in getting IBD occurred. Infants who had more than 2 courses in their infancy had higher risk than those with just one course. The effect appears slightly cumulative–the more doses, the higher the risk.
- Children getting antibiotics before age 5 years and 15 years also had increased risk for IBD, but less so than the infants treated with antibiotics.
- IBD is fairly rare. Here’s how Dr Kronman explained the numbers (and risks) to me:
While there was a high increase in relative risk of IBD between those who were prescribed antibiotics and those who were not (84% overall), the ABSOLUTE risk of IBD is actually quite small in any given person (1 out of 10,000 or so developed IBD in the study, comparable with rates published in other studies). So yes, there was a 6% increased IBD risk with each course of antibiotics, because .000106 is 6% higher than .000100, but these risks are small on an individual level.
Tips For Parents
- The results don’t mean your child will have bowel problems if they’ve had penicillin. The causes of IBD are complex and not perfectly understood–family history and other auto-immune conditions also put children at risk. This data simply helps remind us that each medication we give our children has both benefit and risk.
- Whenever antibiotics are prescribed for your child, ask if they are necessary. Inquire about alternative treatment plans. Discuss the possibility of using probiotics (“good bacteria” capsules and packets) concurrent with antibiotics if you have to use them. Spoonful of Bacteria for Baby? Read about research and information about probiotics and infants
- Don’t ever treat your child with old, unused antibiotics from the cupboard.
- Don’t use antibacterial soap at home — there is no evidence its necessary or more effective at keeping our children healthy and there is some evidence these soaps change patterns of bacteria resistance.
- Avoiding Antibiotics Whenever Possible –blog post about “over-prescribing” & tips for using antibiotics from Healthy Children
What do you think? Do you work to avoid antibiotics when you can? Or have you had the opposite experience—have you had to push for antibiotics in a way that made you uncomfortable?
Emily says
My family moved to Mukilteo, WA right before I started high school– this is only important because I was at the age where conversation with my ped was more important to me than the character on the band aids they provided with shots. The pediatrician we started with was very much conservative when prescribing antibiotics. She was very careful in her explanation to her patients so we understood this reservation, and it’s something that has stuck with me (including not using antibacterial soap at home and looking for a like minded ped for my own child). Taking this in a tangential direction– what about dermatology? The amount of antibiotics prescribed to me and my peer group through middle and high school years would likely supply an entire population of a small third world country. While dermatology is a speciality, there is plenty of patient overlap with pediatrics. And while complexion is superficial by definition, having clear skin is a major point of either confidence or self-doubt. In my experience, the first line of defense for dermatologists treating teens is extended courses of anti-biotics. As we waited for the birth of our son, my husband and I would talk about what the baby might look like and whose features he might carry. We’d always joke that we knew he’d have dark hair, light eyes, and. . .acne as a teenager. As a parent, I would back away from using antibiotics on an otherwise healthy child. But the teenager in me would be first in line at the pharmacy.
Bridget says
Great article. Do you mind explaining the recommendation regarding antibacterial soap at home? I’ve never heard that and am curious if you have brand examples of what not to use vs. what is safe and recommended.
Thanks
Wendy Sue Swanson, MD, MBE says
Hi Bridget,
I don’t recommend you use antibacterial soap because there is no proven benefit to you or your children (over regular soap and water used well) and there are known risks (changes in resistance patterns, particularly in the environment).
Here’s a nice summary from WebMD
https://www.webmd.com/news/20051020/fda-panel-no-advantage-to-antibacterial-soap
Scott says
Have you written about sinusitis? As a pediatrician, the diagnosis of sinusitis drives me nuts. I hate not knowing what is a cold and what isn’t. And 10-14 days is often a harder pill to swallow for parents than giving their kid an antibiotic. I’ve seen it reported as the 5 th most common dx code for acute pediatric visits. Parent daily come in after a week of cold symptoms convinced their children need antibiotics for a “sinusitis”. I think that diagnosis alone accounts for an outrageous amount of antibiotic prescriptions that are likely? unnecessary. If you have some better way to diagnose or to educate patients and parents about the difference between true sinusitis and a longer rhinovirus, please let me know?
Wendy Sue Swanson, MD, MBE says
Hi Scott,
I haven’t written about sinusitis but I certainly know what you mention and how children are given antibiotics after a certain number of days without any proof of “sinusitis.” Particularly when parents worry about the color of mucus (not necessarily bacteria).
I will work on post this winter. Game on commenting?
Justin says
What about hand sanitizer? They use this constantly at my daughters’ daycare — should we be sparing with it?
Wendy Sue Swanson, MD, MBE says
Justin,
Hand sanitizer is safe to use regularly and doesn’t change resistant patterns of bacteria.
Alison Patti says
For those who are interested, there are a variety of tools and resources about appropriate antibiotic use from CDC’s Get Smart: Know When Antibiotics Work program. The main website is http://www.cdc.gov/getsmart and the print materials are at http://www.cdc.gov/getsmart/campaign-materials/print-materials.html. All of them are available to order free of charge in small quantities. There’s even a “prescription pad” for when a patient doesn’t need an antibiotic. Stay tuned for more resources coming out in November during Get Smart About Antibiotics Week (Nov. 12-18).
Aimee says
I wish this information had been published a year ago when my son was an infant and was being prescribed Penicillin for the rash on his face by his Polyclinic pediatrician. I trusted her expertise, but when the issues didn’t resolve with several rounds of antibiotics we did eventually get to see a dermatologist who diagnosed him with Eczema. He got more penicillin when he started having chronic ear infections and then developed a serious allergy to it and broke out in horrible hives all over his body. Then he started getting amoxicillin for his ear infections and then finally ear tubes. I wish I had known then what I do now, and especially given this new information on the other effects of antibiotics. I can only hope to help supplement the good bacteria going into this picky 22 month eater.
Tami says
In your article you say that antibacterial soap is not necessarily good to use and in your comments you say that hand sanatizer is fine. I don’t understand the difference between these two. I am also curious about the sanatizing wipes(like Lysol)?
Wendy Sue Swanson, MD, MBE says
As I understand it Tami, when you use antibacterial soaps sometimes the ingredients only kill some bacteria, not all. Therefore, some bacteria are exposed to ingredients that allows them to change their structure and allow for resistance patterns to develop. Those that survive and form new way to survive amidst that “anti-bacterial ingredients” may be more difficult to cure when they go on to infect people.
Hand sanitizer is bacterial-“cidal”—meaning it kills nearly all bacteria–because of the alcohol content. Therefore bacteria don’t survive and change shape, they just die. Therefore, those hand sanitizers are less likely to contribute to resistant strains of bacteria developing.
Make sense?
Dawn says
My daughter is 7 months old and has VUR in bother ureters, grade 2 in one grade 3 in the other. I am wondering (searching) for alternatives to the indefinite use of Bactrim to treat this condition. She has had 2 UTI’s.
I use Good Bellies probiotic cereal and also culterelle daily. She eats yogurt (Stonyfield YoBaby and Trader Joes organic full fat) pretty much at every meal because she loves it.
I have been told by the pediatrician(s) and the pediatric urologist that the benefit outweighs the risk, and I agree with that, at least kidney-wise, but I worry about my child’s long term health and the repercussions of destroying her gut bacteria. She has been on four different antibiotics since birth.
Any advice you have would be greatly appreciated.
Thank You
Wendy Sue Swanson, MD, MBE says
Dawn,
I would sincerely take trust and get confidence from thinking about the risk versus benefit profile here. This data on the microbiome is just evolving and we have lots of good data on prevention of kidney scarring and damage with antimicrobial prophylaxis, like in VUR, and how much protection (versus) risk it provides. With growth, time, and maturation you’ll likely have options bc of your child growing and changing and potentially getting rid of VUR, surgical correction, or others that may allow you to consider discontinuing the meds. Keep inquiring about timing and the soonest you can get off them, good. But in the mean time take comfort in those expert opinions.
Liz says
My 3 week old newborn had a fever and we took her to the hospital, the first thing they did was hook her up to an iv and started administering ampicillin – an antibiotic. She had no other symptoms and after tests they concluded she just had a virus, which I’m told antibiotics can make worse. I am worried about the long term effects on a newborn being given antibiotics straight into her veins. I have had a lot of health issues due to antibiotics (anemia, Candida, alopecia, and acne) and it took me 5 years of cleansing and taking natural probiotic to help reverse some of those conditions. Even so I wish practitioners were not so quick to prescribe antibiotics without understanding what’s truly wrong.
Kirsten says
Dawn, as a mother of a 12 year old daughter that had VUR early on and was on an antibiotic from 1-4 years old, I encourage you to Become educated on the issue. My daughter has had chronic stomach issues since five years old. Not knowing the long term results of the antibiotic until just last year I had a battery of tests done to figure out what was wrong. Her symptoms primarily consisted of intense abdominal pain, throwing up frequently (usually in the morning), dry skin/excema and more. My husband and I took her for a scope and the doctor said she had Acid reflux. The medicine didn’t seem to help and after many years of doctors we somewhat gave up since some of the symptoms had subsided. However, my daughter is and always has been overweight for her age and despite monitoring her eating habits and teaching her good habits she still struggles with her weight. Of course we don’t make her weight an issue, but even with teaching her good eating habits she has high cholesterol and skin issues. I understand there may be no alternative and I am not a doctor, but I just wish I knew then what I know now.
Good luck to you!
Rebecca says
When I was around one or two I was on antibiotics for an extend period of time. Around 10 months or so, could this still be effecting my immune system today. I am 25 by the way.
Asha says
When I was young ..whenever I get a flu or cold (I used to get sick alot)..my father would insist on antibiotics and also should be IM ..now I’m 28 with about 9 years history with IBS 🙁 I think people should really think so much before using antibiotics or accepting to use them to their kids ..not nessicssarly that you would be stubborn when your kid really needs it but if the doctor is perfectly sure and did what it takes to decide using it ..then you can safely used them .
Fraulein bautIsta says
My child who’s now 1 yr and 4 mos currently has a uti. This is her third time to be diagnosed with uti. We already had kub scan during her second uti and the result was perfectly fine. However, we havent had urine culture this time because the pedia advised that the urine must be collected prior to the administration of antibiotics. Unfortunately we werent able to have a catch and we decided to give her the first dose because sge was already feverish for two days.now, im so worried about my child, esp about the bad side of taking abtibiotics. She had antibitocs before because of amoeba and tonsilitis. She had these illnesses in five month-period. Im concerned that she may have uti again in the future evn if were already taking precautionary measures.Any advise would greatly help.
Dundz says
I am worried because my baby 7 week old then was given Metronidazole for 10 days for suspected amoebiasis..but it turned out to be klebsiella so she was given another round of another antibiotic. What scares me is the Metronidazole box having a warning which says it is carcinogenic to mice. I feel so bad because it might have been needed
K says
I had VUR at birth and was on daily antibiotics for the first 12 years of my life, until I outgrew the condition. I am now 34. I found this thread while doing some research on side effects of long-term antibiotic use, wondering if and how it may have affected me. I am now a bodyworker and very interested in health, wellness, somatics, etc. I am more or less very healthy, and used antibiotics far longer than any example on here, so mothers don’t panic! I do have a sensitive body in general, some allergies, food sensitivities, breakouts, and my immune system sometimes seems to struggle, but there is also evidence that these are genetic and run in my family. I don’t know what the alternative would have been, as I needed those meds to prevent infection. Sometimes there isn’t a perfect solution, but you can pick the best one with the information you have, and trust that that’s enough.
Sunshy9 says
My husband gives my child antibiotic for every illness, even if cold occurs he gives them…. Once her cold was not going and he gave her antibiotics for one and half month…she have became so weak and prone to illness because my husband is not letting her immune system grow….not letting her body produce antibodies…. I’m so fed up of him and he doesn’t listen to anybody, he does this self medication without prescribing from doctor and my child is suffering from his half knowledge.
Julius Beldad says
My daughter of 10 months have been into so many antibiotics. She had a very weak immune system like she had Pneumonia at 1 month+ old and Foot and Mouth Disease and Bronchial Asthma both occurred during her 9th month and she had colds and coughs. All prescribed to be treated with different antibiotics. I am so worried right now if this is going to become dangerous to her.
I was thinking of finding a 2nd opinion maybe to look for a doctor who doesn’t always give antibiotics but would suggest more on herbal or home remedies. How is this antibiotics going to affect my daughter? I have a lot of vitamins for her like 4-5 vits the Doc told me to give.
Thank you.
Immunology student says
@Sunshy9
Your husband is conducting very dangerous behaviour. Not only is he abusing your child’s health as I will explain in a second, he is also threatening public health as exposure to antibiotics may make bacteria resistant, decreasing the ability to treat bacterial infection in the future. Antibiotic resistance is predicted to be the leading cause of global death due to disease in 2050 (exceeding cancer by that time). Furthermore, antibiotics are not likely to cure your child from common cold as this is a viral infection and antibiotics are directed at bacteria. In addition, antibiotics may kill useful bacteria in the gut that your daughter needs to be healthy.
Please let him read this or seek professional help to persuade him. I know he has the best interest in your daughters health and doing this out love for her, but right now he is achieving the opposite.
Stephanie Madill says
Anyone’s baby receive gentamicin?
It’s a neurotoxin that can cause deafness and encephalopathy.
My child received it by IV for 6 days, and has all kinds of issues, like speech delay, inability to focus, short term memory issues, difficulty managing emotions, lack of social skills, and is almost two years behind academically.
Norelyn says
a two months old baby having a cough. she had taken antibiotic for a few days since the cough has gone not following the prescription of the pedia to be taken for a week. Now she had a cough again after a week. Would it be safe to give her antibiotic again? if not what should we do? please respond.