Chronic Antibiotic Use and Its Negative Side Effects: Proactive Nutritional Intervention May Help

Persons with cystic fibrosis are often treated with many courses of antibiotics, both oral, inhaled, and intravenous. This treatment approach is a double-edged sword: while it may help to reduce bacteria counts and even in some cases eradicate bacteria, there is a cost to the body of such chronic antibiotic use.

One, of course, is the development of multi-drug resistant bacteria. Another is the supplanting of one species of bacteria by another species that can better withstand the antibiotics. So, in attempting to eradicate Pseudomonas, chronic antibiotic use has led to a growing number of CF persons culturing bacteria such as S. maltophilia and A. xylosidans. Furthermore, chronic antibiotic use can lead to fungal growth, not only within the gut as the antibiotics eradicate helpful gut bacteria, but even within the lung with the use of inhaled antibotics. Some antibiotics have known nephrotosic and ototoxic effects, where kidney and hearing function are compromised. Chronic oral antibiotic use can lead to kidney stones, for the bacteria that prevents the formation of stones is eradicated within the gut. Chronic antibiotic use can also make the gut more permeable, or "leaky." Furthermore, chronic oral antibiotic use is associated with small bowel overgrowth (SBO) of more harmful fungi and bacteria species.

What to do? A few things can be mentioned. Some clinics recommend constant antibiotic use, even when not sick (such as azithromycin). It would seem to us that this is not a good course of action. Use antibiotics when you need them, and don't use them when you don't need them.

Second, be aware that chronic antibiotic use may cause a severe decrease in levels of magnesium in the body, which can wreak havoc. Take a magnesium supplement while on antibiotics.

Last, an excellent probiotic should be taken while on antibiotics and also for several months after antibiotics have ceased. Deranged gut flora is associated with greater numbers of infections, poor immune response, and worse absorption of nutrients. CF persons already have problems in these areas, and deranged gut flora can make them worse. If there is yeast overgrowth in the bowel, oral yeast killing medications should be sought.

Don't be surprised if your doctor pooh-poohs your suspicion that chronic antibiotic use may actually worsen your health in several ways. Your doctor is looking at your lung bacterial counts as the most important thing. Well, yes,that is very important, but the negative cascading side effects of chronic antibiotic use may end up compromising the very goal for which they were used in the first place. It is possible to try and blunt some of the unwanted negative side effects even while using these powerful drugs, and we urge CF persons to be attentive to this issue.