There is an old adage that the only certainty is change. Last week a new advisory, published in the BMJ, came out saying we do not need to finish a course of antibiotics. Interestingly one of the reasons for this is a compete reverse of the previous view. It was believed that antibiotic resistance was increased if a course was not finished. The new view is that taking more antibiotic than needed increases resistance.
Below are three key messages from the BMJ review
1) Patients are put at unnecessary risk from antibiotic resistance when treatment is given for longer than necessary, not when it is stopped early.
2) For common bacterial infections no evidence exists that stopping antibiotic treatment early increases a patient’s risk of resistant infection.
3) Antibiotics are a precious and finite natural resource which should be conserved by tailoring treatment duration for individual patients.
4) Clinical trials are required to determine the most effective strategies for optimising duration of antibiotic treatment.
When you think about it logically, it makes sense that using more antibiotics would increase the likelihood of resistance whereas stopping it earlier would not.
The course length of antibiotics is based on fairly old research. It also assumes that all infections and all people are the same and that both bacteria and people respond in the same time frame. It is also salient to recall that many antibiotics do not actually kill the bacteria but simply stop them multiplying. Thus, it buys the body’s immune system time to get on top of the infection.
And of course, we now know that cold and flu like illnesses are caused by viruses not bacteria. In turn, this means that an antibiotic will not help as viruses do not respond to antibiotics. It used to be thought (and unfortunately many still do) that a course of antibiotics given unnecessarily was “harmless”. It is not.
It exposes the bacteria to antibiotic which means that those bacteria which can adapt do. These bacteria will multiply. This is how antibiotic resistance increases. Natural selection favours those who can adapt over those that cannot. Also, antibiotics can interfere with our good bacteria and this can have numerous knock on effects in terms of our health.
So the take home message is do not use an antibiotic when you have a viral illness and if you have a bacterial infection you can stop the course when you are recovered. This is regardless of whether the course has been completed.
A second interesting study has shown that sperm concentration has dropped 50% in 40 years in Europe, North America and Australia. This is a significant drop in a short space of time even allowing for some questions over the validity of early data. The study looked at 42,000 men in 185 studies between 1973 and 2011.
With more couples have difficulty conceiving, this is a significant piece of the jigsaw. The next question is what has caused it. There are likely numerous contributors. One that keeps coming up is exposure to endocrine disruptors such as bisphenol A(BPA). This is found in hard plastics such as microwave safe take away containers and plastic water bottles. When heated they can leach into the food.
Whilst BPA’s have been declared safe, this is because they are not immediately toxic. But long-term effects are only seen after many years. BPA’s have also been implicated in an increased incidence of breast cancer.
Once again – keep it simple. The less exposure to substances that the body does not need, the better it is for us. The question is less is it safe or is it harmful but, does the body need it. If the answer is no, then minimise your intake or exposure.