Avoiding antibiotics for mild infections may be beneficial long-term. Available data suggest different antibiotics perturb human microbiota differently (1; see below from 2).
- Some broad-spectrum antibiotics clear out many more organisms than others.
- Some antibiotics have a more long-term impact than others.
Epidemiological studies suggest antibiotics especially when given in early life could have a long-term impact on immune function, specifically in the form of increased risk for immune disorder-linked diseases such as asthma, other allergies such as eczema, and IBD () such as (see below from ).
Antibiotics can clear out large swaths of human body-associated microbiota. This can lead to
- Loss of microbial diversity that may entail metabolic alterations.
- Increase bacterial drug resistance.
All these effects can indirectly damage a person’s immune function (see below from 2).
Indirect since antibiotics especially broad-spectrum eliminate many bacterial species making it patently difficult to directly attribute a particular immune function defect to loss of any one specific microbe. Thus, the story perforce needs to be stitched from two disparate pieces of information, each with inherent limitations and biases,
- Epidemiological assessments of long-term effects of antibiotic exposure on human populations, and
- Analysis of specific immune system changes after specific experimental antibiotic administration in mouse models.
Epidemiologically, early life antibiotic Rx is strongly associated with several immune disorder phenomena
- Asthma (4, , , , ).
- Asthma risk as a consequence of greater risk of respiratory tract infection ( , , ).
- Food Allergy ( , 13).
- Eczema (no: , yes: 15).
- IBS ( ) and IBD ( ) (16, , ) including Pediatric Crohn’s disease ( ).
Specific immune system changes in response to specific experimental antibiotic administration in mouse models
See below from.
1. Cervantes, Jorge. “Use your antibiotics wisely. Consequences to the intestinal microbiome.” FEMS microbiology letters 363.10 (2016): fnw081.
2. Lange, Kathleen, et al. “Effects of antibiotics on gut microbiota.” Digestive Diseases 34.3 (2016): 260-268.
3. Langdon, Amy, Nathan Crook, and Gautam Dantas. “The effects of antibiotics on the microbiome throughout development and alternative approaches for therapeutic modulation.” Genome medicine 8.1 (2016): 39.
4. Droste, J. H. J., et al. “Does the use of antibiotics in early childhood increase the risk of asthma and allergic disease?.” Clinical & Experimental Allergy 30.11 (2000): 1548-1553.
5. Kozyrskyj, Anita L., Pierre Ernst, and Allan B. Becker. “Increased risk of childhood asthma from antibiotic use in early life.” CHEST Journal 131.6 (2007): 1753-1759.
6. Risnes, Kari R., et al. “Antibiotic exposure by 6 months and asthma and allergy at 6 years: findings in a cohort of 1,401 US children.” American journal of epidemiology 173.3 (2011): 310-318.
7. Russell, Shannon L., et al. “Early life antibiotic‐driven changes in microbiota enhance susceptibility to allergic asthma.” EMBO reports 13.5 (2012): 440-447.
8. Stensballe, Lone Graff, et al. “Use of antibiotics during pregnancy increases the risk of asthma in early childhood.” The Journal of pediatrics 162.4 (2013): 832-838.
9. Mai, X‐M., et al. “Antibiotic use in early life and development of allergic diseases: respiratory infection as the explanation.” Clinical & Experimental Allergy 40.8 (2010): 1230-1237.
10. Heintze, Konrad, and Karl-Uwe Petersen. “The case of drug causation of childhood asthma: antibiotics and paracetamol.” European journal of clinical pharmacology 69.6 (2013): 1197-1209.
11. Teo, Shu Mei, et al. “The infant nasopharyngeal microbiome impacts severity of lower respiratory infection and risk of asthma development.” Cell host & microbe 17.5 (2015): 704-715.
12. Metsälä, Johanna, et al. “Mother’s and offspring’s use of antibiotics and infant allergy to cow’s milk.” Epidemiology 24.2 (2013): 303-309.
13. Stefka, Andrew T., et al. “Commensal bacteria protect against food allergen sensitization.” Proceedings of the National Academy of Sciences 111.36 (2014): 13145-13150.
14. Kummeling, Ischa, et al. “Early life exposure to antibiotics and the subsequent development of eczema, wheeze, and allergic sensitization in the first 2 years of life: the KOALA Birth Cohort Study.” Pediatrics 119.1 (2007): e225-e231.
15. Tsakok, T., et al. “Does early life exposure to antibiotics increase the risk of eczema? A systematic review.” British Journal of Dermatology 169.5 (2013): 983-991.
16. Hviid, Anders, Henrik Svanström, and Morten Frisch. “Antibiotic use and inflammatory bowel diseases in childhood.” Gut (2010): gut-2010.
17. Shaw, Souradet Y., James F. Blanchard, and Charles N. Bernstein. “Association between the use of antibiotics in the first year of life and pediatric inflammatory bowel disease.” The American journal of gastroenterology 105.12 (2010): 2687-2692.
18. Villarreal, Armando A., et al. “Use of broad-spectrum antibiotics and the development of irritable bowel syndrome.” Wmj 111.1 (2012): 17-20.
19. Virta, Lauri, et al. “Association of repeated exposure to antibiotics with the development of pediatric Crohn’s disease—a nationwide, register-based Finnish case-control study.” American journal of epidemiology 175.8 (2012): 775-784.
20. Becattini, Simone, Ying Taur, and Eric G. Pamer. “Antibiotic-induced changes in the intestinal microbiota and disease.” Trends in molecular medicine 22.6 (2016): 458-478.