Using Antibiotics Correctly

Did you know that for every human cell in your body, there are five to 10 bacterial cells? All those bacteria help educate our immune system, regulate our metabolism and prevent colonization by harmful pathogens.

The majority of bacteria in the human body live in the gut, making up what’s called the microbiome. Gut bacteria help with digestion. We’re also learning that the microbiome may have connections to acute and chronic conditions such as asthma and obesity. Research in animals has shown that if you give mice antibiotics, they end up fatter. All these bacteria serve a purpose, and when we take an antibiotic, that antibiotic doesn’t just go to your infected ear or sore throat; it also goes to your gut and can change your microbiome.

That is not to say antibiotics aren’t helpful. They can save lives. If you or your children have certain types of bacterial infections, you might need them, but medical research is learning that antibiotics are often prescribed when they shouldn’t be. Antibiotics are the most common prescription medicines given to children. Some are narrow-spectrum, killing only a few types of bacteria, and some are broad-spectrum and kill many types of bacteria. Both types work well to treat certain infections. But, just like using antibiotics when they aren’t indicated at all, using broad-spectrum antibiotics when you don’t need them could have adverse effects. You want to kill the bad bacteria causing the infection, not the good bacteria helping keep you healthy.

I took part in a three-year study comparing two different types of antibiotics for ear, sinus or throat infections in children. These infections account for about half of all antibiotic use in kids. We called parents five and 10 days after their child’s diagnosis to ask about how quickly they were cured and the side effects of the medicine. We found there was no difference between broad- and narrow-spectrum antibiotics with respect to curing the infection, but the broad-spectrum drugs caused significantly more side effects. Specifically, kids who received broad-spectrum antibiotics had 25 percent more diarrhea than those who received narrow-spectrum antibiotics, probably because of how broad-spectrum antibiotics disrupt the gut microbiome.

What’s been unique about this project, funded by the Patient-Centered Outcomes Research Institute (PCORI), is that we were encouraged to engage with patients, parents, and other groups in all stages of the project. PCORI supports research that is guided by patients, caregivers, and the broader healthcare community with the goal of focusing on outcomes that are important to patients.

One of our most important findings was that when we listened to parents involved in our research, we learned which outcomes they found most important. For example, parents cared about disruptions in the child’s sleep as well as school or daycare attendance, and their own ability to get to work. But those aren’t the outcomes that researchers typically consider.

When you talk to doctors, most perceive pressure from patients and parents to prescribe antibiotics. But parents are just looking for more information about what’s wrong with their child, what can be done to make their child better, and how long it might take. Providing that kind of basic information can avoid the potential for improper antibiotic use. It’s important, as a parent of a sick child, to be able to trust your doctors. But in any situation, a parent should expect a very clear explanation for how they child is being treated, why an antibiotic is indicated and what potential side effects may occur.

Photo by on Unsplash

Jeffrey Gerber, MD, PhD

View posts by Jeffrey Gerber, MD, PhD
Jeffrey Gerber, MD, PhD is an attending physician, Division of Infectious Diseases, Children’s Hospital of Philadelphia (CHOP)

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