What to take away?

Drug

Pulmonology Pediatrics Otorhinolaryngology Gastroenterology

Commonly hailed as one of the most important advances of the 20th century, antibiotics have saved millions of lives.

About this article

Created 25 August 2021

Updated 07 January 2022

They also had, however, a deleterious impact on microbiota:

antibiotic-induced dysbiosis, which is associated with both short- and long-term health consequences;
host-specific pool of antimicrobial resistance genes and organisms developing as a result of the misuse or overuse of antibiotics.

This points to the need for antibiotics to be handled with care, and that a more rational use of antibiotics be adopted.

Antibiotic-induced dysbiosis can affect every human microbiota:

Gut microbiota:
Diarrhea, its main short-term side effect, occurs in up to 35% of patients receiving antibiotics;^1,2,3
Urogenital microbiota:
Following antibiotic treatment, between 10 and 30% of women go on to develop vulvovaginal candidiasis;⁴
Cutaneous microbiota:
60% of patients treated for acne have macrolid-resistant Cutibacterium acnes strains;
Ears-nos-throat microbiota:
Antibiotics administered for upper respiratory tract infections increase by a factor of 2.6 the incidence of acute otitis media;
Lung microbiota:
Broad-spectrum antibiotics used for treating lung infections are regarded as one of the principal contributors to the overall burden of antibiotic resistance.

What to do?

To prevent dysbiosis:

adopting a more diverse diet, high in fiber: diet has a considerable influence on the composition of the intestinal microbiota;⁵
using probiotics⁶: when administered in adequate amounts these live microorganisms (yeasts or bacteria) confer a definite health benefit on the host;⁷
using prebiotics: substrates that are selectively utilized by host microorganisms and which thereby confer health benefits.⁸

To promote the reconstruction and the functionality of a dysbiotic microbiota:

using probiotics (yeasts or bacteria) may be helpful;⁶
considering fecal microbiota transplantation to treat recurrent Clostridioides difficile infection only.⁹

To combat antimicrobial resistance:

explore phage therapy:¹⁰ phages, the natural predators of bacteria, were used to treat bacterial infections before the advent of antibiotics;
investigate CRISPR-Cas9:¹¹: these “molecular scissors” could be used to implement corrections to genes;
consider nanomaterial-based therapies:¹²: the physical properties of certain nanomaterials endow them with the capability to target biofilms.

Sources

^{1 McFarland LV, Ozen M, Dinleyici EC et al. Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections. World J Gastroenterol. 2016;22(11):3078-3104.}

^{2 Bartlett JG. Clinical practice. Antibiotic-associated diarrhea. N Engl J Med 2002;346:334-9.}

^{3 Theriot CM, Young VB. Interactions Between the Gastrointestinal Microbiome and Clostridium difficile. Annu Rev Microbiol. 2015;69:445-461.}

^{4 Shukla A, Sobel JD. Vulvovaginitis Caused by Candida Species Following Antibiotic Exposure. Curr Infect Dis Rep. 2019 Nov 9;21(11):44.}

^{5 Levy M, Kolodziejczyk AA, Thaiss CA et al. Dysbiosis and the immune system. Nat Rev Immunol. 2017;17(4):219-232.}

^{6 Guarner F, Sanders ME, Eliakim R, et al. World Gastroenterology Organisation Global Guidelines. Probiotics and Prebiotics. 2017}

^{7 FAO. Probiotics in Food: Health and Nutritional Properties and Guidelines for Evaluation (Food and Agriculture Organization of the United Nations, Rome, 2006)}

^{8 https://isappscience.org/for-scientists/resources/prebiotics/}

^{9 Cammarota G, Ianiro G, Tilg H, et al. European consensus conference on faecal microbiota transplantation in clinical practice. Gut 2017 ; 66 : 569-80.}

^{10 Langdon A, Crook N, Dantas G. The effects of antibiotics on the microbiome throughout development and alternative approaches for therapeutic modulation. Genome Med. 2016;8(1):39.}

^{11 Gholizadeh P, Köse Ş, Dao S, et al., How CRISPR-Cas System Could Be Used to Combat Antimicrobial Resistance. Infect Drug Resist. 2020 Apr 20;13:1111-1121.}

^{12 Makabenta JMV, Nabawy A, Li CH et al. Nanomaterial-based therapeutics for antibiotic-resistant bacterial infections. Nat Rev Microbiol. 2020 Aug 19.}

Tags

Otitis Probiotics AAD Microbiome Flora

See also

Antibiotic exposure during first six years of life disrupts gut microbiota and impairs child growth

A new generation of antibacterial agents? A plasmid capable of killing pathogenic bacteria

Antibiotic resistance: the lung microbiota pays a heavy price

Focus

The Janus face of Antibiotics: Life Savers & Microbiota Disrupters

Introduction

The Janus face of Antibiotics: Life Savers and Microbiota Disruptors

Gut

From diarrhea to chronic diseases: the well-documented consequences of antibiotic-related gut microbiota dysbiosis

Urogenital

Urogenital microbiota: the spectrum of mycosis or urinary tract infections after each antibiotic treatment

Cutaneous

Antibiotics, a double-edged sword when managing skin disease

ENT

Ears, Nose and Throat microbiota: when antibiotics challenge our first line of defense

Lung

Antibiotic resistance: the lung microbiota pays a heavy price

Conclusion

What to take away?

What's worth reading about microbiota

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The Janus face of Antibiotics: Life Savers & Microbiota Disrupters

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