It's time to talk about antibiotics. I'll admit, it's not an easy topic. I haven't heard so many myths and fears about any other group of medications. We even started evaluating children's health based on how many courses of antibiotics they've taken in their lifetime. So, what are antibiotics, why are they necessary, and why should we try to use them as little as possible?
Antibiotics are natural or synthetic substances that destroy bacteria or inhibit their growth and reproduction. I would really like to highlight or repeat this definition several times, especially the part that indicates that antibiotics only destroy bacteria, not viruses. Therefore, antibiotics should not be prescribed for viral infections. They are not a panacea for all illnesses.
Before antibiotics were discovered, many people died from complications of bacterial infections. During those times, it was not surprising that only a few children out of many born would reach adulthood. Most people couldn't withstand bacterial infections, which were very common due to poor hygiene levels.
However, times have changed. Knowledge about infectious agents has increased. Initially, it was believed that bacteria posed the greatest threat, but during quarantine, we realized that viruses are no less dangerous. Many drugs have been discovered, including antibiotics. It would seem that we should rejoice – diseases caused by bacteria should no longer scare us. However, it appears that we may have gone too far.
Antibiotics were invented to protect us from complications of bacterial infections and to prevent death. But perhaps we forgot that our immune system has excellent tools and mechanisms to protect us from disease-causing bacteria. After all, our immune system can easily handle a small pustule on the skin. So why don't we trust our bodies enough to allow the immune system to try to identify and destroy the pathogen in cases of mild bacterial infections that do not bother the child (or adult)? Why don't we let the child's immune system learn to recognize and fight off bacteria? If the child doesn't start learning on their own, they will never learn to resist bacteria.
Of course, if there is a bacterial infection, there is a risk of complications. Therefore, such a child needs to be monitored by doctors, evaluated to see if they still have the strength to fight, whether they are making mistakes, explaining to parents how to properly assess the child's condition, and only when absolutely necessary, provide appropriate treatment. Some children do an excellent job coping and eliminating bacteria, while others also do well but gradually show signs of fatigue, such as mood swings, loss of appetite, and tired eyes indicating deteriorating health, and of course fever. Well, this time it didn't work out, we'll help with antibiotics, but at least the child learned a little and made an effort. Of course, I'm not talking about acute and severe infections where rapid response and appropriate treatment are needed.
However, there are parents who, as soon as they walk through the doctor's door, declare that they only came to have antibiotics prescribed for their child. It takes half an hour to convince others that the child won't get better without antibiotics. And I'm never sure whether I manage to convince the parents or not.
There are various doctors too. I am happy that more and more doctors prescribe antibiotics thoughtfully, only when they are truly convinced that the child needs them. But there are still many who prescribe them based on fictitious diagnoses such as "sick for too long", "just in case", "weekend is approaching" or "it helped last time, so it's needed now". Many doctors do not have the time, mood, or simply do not want to explain to parents why a particular treatment is prescribed, how to evaluate whether antibiotics are working, and whether the child is getting better. If parents have doubts, they either seek a second opinion or simply do not give the medication, risking the child's health. Admit it, how many times have you not given your child antibiotics, the child recovered, and you deceived the doctor that you followed their instructions?
So why do we talk so much about antibiotics and the need to use them very responsibly? Irrational use of antibiotics, incorrect dosages, or too short courses pose a risk of developing antibiotic resistance. This means that specific antibiotics will no longer work against certain bacteria; they will become weaker. Therefore, when a child truly needs antibacterial treatment, the prescribed antibiotics will be ineffective, and there will be a high risk of complications.
How does antibiotic resistance develop? Bacteria, whether "good" or "bad," are living organisms that want to live, eat, and multiply. Therefore, they have developed many mechanisms to evade the effects of antibiotics. One way bacteria protect themselves is by preventing the antibiotic from entering their insides through the membrane. These bacteria become impermeable to antibiotics. Some bacteria have learned to produce enzymes that alter or degrade the antibiotic to neutralize it. Antibacterial substances bind to certain molecules of a bacterium, so bacteria learn to change or mask those molecules. Additionally, bacteria defend themselves by quickly "spitting out"—removing the active antibiotic from the cell. Those bacteria can come up with anything.
To put it simply, when an infection occurs and antibiotics are taken, just like in a battle, the weakest bacteria are the first to perish. The strongest remain. Therefore, by stopping antibiotic treatment too early or by using incorrect dosages, the surviving resilient bacteria, i.e., ones resistant to these antibiotics, will multiply and remain in our bodies. After receiving the same antibiotics again, which will now work less effectively, the stronger resistant bacteria will persist, and hence those bacteria for which certain antibiotics are no longer viable. Furthermore, we share bacteria with our environment just like viruses. Therefore, the people around us may become infected with bacteria that will require more potent, different, or broader-spectrum antibiotics for eradication. Unfortunately, the list of antibiotics is not long.
The whole world is shouting — we are running out of antibiotics. We have reached a point where there are almost no alternatives left to treat some bacterial infections. The consequences are visible worldwide, as more and more bacterial infections become untreatable. The last discovery of a new class of antibiotics to reach the market was in 1987.
The predictions are not optimistic: it is estimated that by 2050, deaths due to antibiotic resistance per year will be 317,000 in North America, 390,000 in Europe, 392,000 in Latin America, 4,150,000 in Africa, and 4,730,000 in Asia. The World Health Organization has estimated that by 2050, the number of deaths related to antibiotic resistance could reach 10 million!
It would be wrong to think that nothing is being done in this regard. Scientists are working, and clinical trials are being conducted. However, it is time-consuming and extremely expensive. It is hoped that approximately ten new antibiotics will enter the market within ten years. However, it is announced that only six of these candidates meet one or more WHO criteria. And of these six "innovative compounds," only two are active against multidrug-resistant, so-called "critical" category bacteria.
People are also seeking other alternative treatment methods to prevent bacterial infections. For example, bacteriophages are increasingly being discussed — viruses that destroy bacteria. Viruses enter the cell and destroy it, so why not design these viruses to target only disease-causing bacteria? I believe we will hear more about this in the future. Scientists are also exploring ways to revitalize older antibiotics that are not being used for various reasons. Antimicrobial peptides are being investigated too —compounds produced by our immune cells. So why not learn from our immune system?
Unfortunately, we need to talk not only about bacterial resistance to antibiotics. Antibiotics are medications, and there are no medications that do not cause side effects. Possible short-term or long-term health consequences. The most important, I would say, is the effect on the microbiota. When it was discovered that we are not sterile organisms and that we harbor many bacteria, that there is a separate organ—the microbiota, the imbalance, i.e., dysbiosis, began to be increasingly associated with antibiotic use. If antibiotics kill the "bad" microbes, they can harm our "good" bacteria. The longer the course of antibiotic therapy, the more potential harm can be done to the body's immune system.
The microbiota and the immune system are closely related. Numerous studies have been carried out and are ongoing on this issue. Antibiotic use is associated with reduced microbiota diversity. It has become a rule that probiotics should be taken when antibiotics are taken. Even a single dose of antibiotics has an impact on the gut microbiota. This can be compared to burning a finger—briefly holding it over a flame; if the burn is easy, the wound will heal, and the skin lines characteristic of a finger print will reappear. How long does it take? Although the initial composition of the gut microbiota usually fully recovers within 1.5 months, but several regular bacterial species were not found in some subjects after 180 days.
By the way, I want to clarify that reduced diversity does not necessarily mean a decreased number of bacteria. By eliminating bacteria sensitive to antibiotics, bacteria resistant to antibiotics proliferate and take their place. In fact, the overall microbial amount may increase after antibiotic treatment, even if species diversity declines. Some studies have found that the total number of microbes after antibiotic treatment may even double. And too much of something can also be bad for our health.
A healthy gut is characterized by the stability and integrity of the epithelium, which is maintained by various mechanisms, such as a dense layer of mucus and strong connections between epithelial cells. Our gut microbiota produces substances that inhibit the growth of pathogenic bacteria. These substances accumulate in the mentioned mucus layer. When antibiotics are taken, some microbiota bacteria die, reducing the levels of these antimicrobial substances. Additionally, some antibiotics directly damage the mucus layer and make it thinner. As a result, the intestinal mucosa becomes more vulnerable, and the gut is less protected, making it more prone to intestinal infectious diseases. The disrupted gut function will lead to more frequent respiratory illnesses, as there is a close connection between the gut and respiratory tracts.
What other adverse reactions might occur with antibiotic use? These reactions can be short-term or long-term—from digestive issues and bone damage to sensitivity to sunlight. Digestive tract symptoms may include nausea, gastrointestinal disturbances, vomiting, diarrhea, abdominal bloating or fullness, loss of appetite, or stomach pain. Children may complain of stomachache, usually a few hours after taking antibiotics. The pain can be short-term, or the child may feel discomfort in the gut throughout the course of antibiotic treatment and even for some time after. One of the most common short-term adverse reactions is antibiotic-associated diarrhea, which can last for the duration of antibiotic use and up to eight weeks following antibiotic treatment. The frequency of antibiotic-induced diarrhea is 5–35%.
Scientists are particularly concerned about the long-term consequences of antibiotic use. An established link exists between early antibiotic use and childhood asthma, allergies, and respiratory diseases. Unfortunately, more evidence is emerging that antibiotic use is associated with more frequent gastrointestinal tract infections, weight gain and obesity, inflammatory bowel diseases, and the development of colon and rectal cancer.
I do not wish to frighten or discourage you with this article. I simply want to ask that we take a very responsible approach to children's health. Antibiotics have saved many lives. Without them, we would be incapable of dealing with widespread bacterial infections, but they are not universal medications. Everything given to a child's body must be justified, carefully considered, and felt with a tremendous sense of responsibility. The most important thing is not to cause harm.