When should you say no to antibiotics?
Doctors are cutting back on the use of antibiotics. Thea Jourdan reports on how to protect yourself if you have to take them
The days when antibiotics were doled out like Smarties for every cough and sniffle are long gone. Overall, prescription rates have dropped dramatically in the last few years as doctors try to combat the rising problem of antimicrobial resistance.
Last week, researchers warned that antibiotics may actually harm children who take them. Scientists at the University of Oxford and Public Health England found that preschoolers who take antibiotics for coughs and colds are more likely to get ill in the future.
Their study, published in the latest issue of the British Journal of General Practice, looked at 250,000 children aged one to five and found that those who had more than two courses of antibiotics were 30 per cent more likely to visit a doctor or spend time in hospital. Scientists believe the drugs may kill beneficial bacteria in the gut.
Professor Helen Stokes‑lampard, chairman of the Royal College of GPS, says: “This research drives home how important is it for patients – and particularly parents – to understand antibiotics do not work for every infection and should not be prescribed for the most common childhood conditions… which are usually caused by viruses.”
Sometimes, though, antibiotics are unavoidable. So how do you know when you really need them, and how can you protect your health if you’ve no choice but to take a course?
The golden rules
“Antibiotics can be life‑saving drugs for severe infection‑related conditions such as sepsis,” says Professor Stokes‑ Lampard. “But instances where children who have an infection really do need antibiotics should be relatively uncommon.”
Dr Fiona Cornish, a GP in Cambridge, says antibiotics should still be prescribed when really needed. “I will always do my best to prescribe antibiotics appropriately, for example, in the case of someone who is suffering from a severe urinary tract infection. We need to be careful not to withhold antibiotics when they are actually the best remedy available.”
There are some groups – people with cystic fibrosis, for example – who have to take antibiotics daily to keep themselves healthy, she adds. “Women with cystitis may also need antibiotics, particularly if the problem is severe or they are pregnant.” Older people with urinary tract infections do better when they are given doses of antibiotics early on, according to a study this year by Imperial College London and Public Health England.
When you are given antibiotics, the golden rule is always take the course as directed. “Patients should take them as directed and finish the entire course, even if you start to feel better,” says Professor Stokes‑lampard.
Dr Cornish suggests checking with your doctor that the antibiotic you are being given is the right one – antibiotics that treat a narrow spectrum of bacteria are generally better than broad spectrum antibiotics.
Depending on a person’s symptoms, GPS will sometimes issue a delayed prescription for a patient to collect if their condition (or that of their child) doesn’t improve, or starts to get worse over the coming days.
Probiotic power
Research by University College London found that a single course of antibiotics can change the composition of the microbiome for at least a year. But when you do have to take them, there are ways to minimise the damage to your gut microbiome, which is made up of a complex community of trillions of bacteria. Glenn Gibson, professor of food microbiology at the University of Reading, says it’s “essential” when taking antibiotics to take prebiotics – which provide nutrition for microbes – and probiotics, which are living microbes that can be taken as capsules, pills or in food form. “They can certainly help resist the negative effects of antibiotics on the gut microbiome. They are routinely given in some countries when antibiotics are prescribed. That should happen here too.”
Prof Gibson recommends Bimuno for a prebiotic and Danone Actimel as a probiotic. He believes that people should take them regularly for general good health and does so himself, but if you’re taking antibiotics, he advises taking them, “as a minimum”, during the course and for a week after finishing it. “They can help with issues such as gastroenteritis, IBS, transit time, and abdominal discomfort (including gas). Current research is also looking at brain effects and influences on the symptoms of obesity.”
The good gut diet
“There’s a lack of really good quality evidence but some studies do seem to show that eating prebiotic and probiotic foods can reduce the impact on the microbiome of taking antibiotics,” says Prof Tim Spector, professor of genetic epidemiology at King’s College London and author of The Diet Myth.
“For me personally, it’s the three Ks; kefir, kombucha and kimchi.” Kefir is a super yogurt drink that contains five time the diversity of microbes as traditional yogurt, kombucha is a Russian tea drink that contains yeast and fungi, and kimchi is a spicy fermented cabbage pickle from Korea rich in “good” lactobacilli and bifidobacteria. Sauerkraut is the less spicy version, and another excellent prebiotic food.
As a fizzy drink, kombucha can seem like a treat to children, but if they’re turning their noses up at the three Ks, try mixing kefir in with their favourite yogurt or ice cream.
Prof Spector also advises people who need to take antibiotics to protect their gut flora by avoiding artificial sweeteners.
“Gut microbes can’t easily process these and produce weird metabolites which seem to have a damaging effect. Also, stay away from highly processed food that contains lots of chemicals which disturb the balance in the gut.”
Eating plenty of fibre can help nourish the good bacteria that thrive in the lower intestine, he advises. “Plant foods high in polyphenols, such as nuts, berries, olive oil and red wine, may also enhance the growth of beneficial bacteria.”
And mothers who are breastfeeding a child who is taking antibiotics are helping to boost their child’s good gut bacteria, he says. “It’s how a mother passes good bacteria on to her baby and will help ameliorate any harmful effects of the drugs.”
‘We must understand that antibiotics do not work for every kind of infection’