Antibiotic-associated diarrhea - (AAD)
Antibiotics -- to Take or Not to Take?
by David A. Holland, M.D.
I looked up antibiotics in Harrison’s Textbook of Internal Medicine. The listing referred me to "antimicrobials." This caused me to realize how much more accurately the second term describes these substances, given the broad-spectrum nature of a lot of them.
I must confess that, as a doctor, I do prescribe "antimicrobials." Perhaps I prescribe more antifungals and nonprescription remedies than the usual doctor, but I do prescribe antibiotics, as well. Perhaps even more horrifying, considering Doug’s articles condemning them, is that I’ve taken them myself! In fact, in these times it’s a rare individual who goes through life without ingesting those little pills. So, three questions have become important -- when should you take antibiotics, when should you refrain, and what will you do when you’ve already taken them?
Alexander Fleming, by the grace of God, brought us a mixed blessing in 1928 with his accidental discovery of penicillin produced by, of all things, a fungus. Medicine’s interest treating people for exposure to fungi dropped dramatically in succeeding years, until the microbes were only thought important insofar as their ability to produce increasingly diverse varieties of antibiotics.
Interest in fighting bacteria proliferated like a flesh-eating Strep infection, fueling the race to discover ever more antibiotics. Pharmaceutical salespeople invaded doctors’ offices and hospitals, intent on convincing physicians their antibiotic was better than the others. These salespeople supported their pitches with studies, graphs, charts and convincing stats, while often failing to mention that their research had been funded by their own companies. The possible conflict of interest was, and remains, enormous.
I have no quarrel with such salespeople. They’re regular men and women like you and me, just trying to make a living. However, when human lives are involved, funding research to prove that your own product is better than the competition’s is just plain wrong. The advantage is obvious, and the danger that a great deal of objectivity could be lost is only all too real.
I believe that an impartial, third party should be assigned to perform such research, funded by a mandatory "ante" from all pharmaceutical companies involved in producing a given category of drug. Of course, that will be the day! In case the above scenario never happens, we would do well to take with several grains of salt the unregulated information that companies provide about their own products.
Perhaps you are wondering about the use -- and abuse -- of antibiotics in general. Let me give you an example. One of the most common diagnoses given at a doctor’s office is the upper respiratory infection (URI). It accounts for up to 70 percent of all antibiotics dispensed (Annals of Internal Medicine. American College of Physicians. American Society of Internal Medicine. March 20, 2001).
However, according to Dr. Carol Kauffman, most URIs are not caused by the bacteria that antibiotics are designed to fight. Rather, Kauffman says, they are caused by fungi. So, unless a secondary, bacterial infection presents itself -- and even then, the rules change -- most URIs do not require the use of antibiotics.
Regarding ear infections, in one study, children administered antibiotics for acute otitis media suffered double the rate of adverse effects compared to children in the study who took placebos (Clinical Evidence. 2000). The difference in outcome for those children in the study who took antibiotics compared to those who do not was almost negligible. Some scientists counter that children who take antibiotics run lower risks of secondary ear infections such as meningitis or mastoiditis (infection of the angular bone located behind your ear).
Of course, the landscape is complicated by noncompliance. The portion of people who take their antibiotics as prescribed has been estimated at anywhere between 8 to 68 percent. So it’s difficult to say just how effective antibiotics actually are.
Now, say my daughter were to get sick for 10 days, miserable with a high fever and screaming ear pain. Say our doctor said her ear canal checked out as angry red. Am I going to have my daughter take the prescription? Probably so. We cared for a young woman at the hospital where I worked who was literally at her death bed with overwhelming Streptococcal -- bacterial -- pneumonia. One of her lungs was saturated with the infection, which had also spread throughout her bloodstream.
I went on to my next rotation thinking that was the last I would hear of that patient. However, I later spoke with her attending physician. He told me she walked out of that hospital, completely cured. So, antibiotics save lives, but it’s not exactly a common occurrence. Certainly, most of you out there suffering from the common cold are not near death, so you should think twice about taking antibiotics.
The non-synthetic antibiotics are fungal by-products called mycotoxins. Penicillin is perhaps the best example. In other words, mycotoxins kill off fungi’s competitors, allowing fungi to grab up all of the nutrients for themselves. Alexander Fleming himself observed this in action, and it later led him to develop penicillin. When a mold -- molds are fungi -- contaminated a bacteria colony upon which Fleming was performing an experiment, the invader cleared the area around it of all bacteria. When Fleming investigated, It turned out that the fungus had produced a substance he would later call penicillin, killing the bacteria in residence.
Just because they kill bacteria, you may be thinking, doesn’t mean that some, many or especially all of the mycotoxins used as antibiotics are necessarily harmful to human beings. A. V. Costantini in effect counters this idea when he speaks of the work of two scientists by the name of Bernstein and Ross. Costantini says that the men found that two or more months of treatment with penicillin and other antibiotics contributed to what they saw as a "significantly increased risk of non-Hodgkin’s lymphoma in humans (Costantini, A. V. Fungalbionics. 1998)."
How many people, children included, have undergone dose after dose of antibiotics for recurring infections? Doug and I believe that these relatively small doses taken over long periods of time are actually harming us in similar, incremental fashion, later showing up as cancer, diabetes, vasculitis or other diseases.
We take antibiotics when we are sick, when our immune systems weaken. The mycotoxins pharmacies dispense for use as antibiotics only exacerbate the problem, because the lion’s share of these substances have been shown to be immunosuppressants (CAST Report No. 116. November 1989.). Not only are they capable of hamstringing our immune systems, they also destroy the friendly bacteria that guard our intestines.
These friendly bacteria include Lactobacillus acidophilus, Bifidus and Bulgaricus, supplements for which can be found in any health food store’s refrigerated section. They protect us against pathogens such as Salmonella, yeast, cholera, and the bad E. coli. They are so potent that, prior a trip abroad, to protect yourself from traveler’s diarrhea you’d do better to skip the usual antibiotics and instead take acidophilus supplements.
Unfortunately, these good flora are so vulnerable to antibiotics that, in mice, a "single injection of streptomycin can eradicate the protective effect of the normal flora. (Mandell. Principles and Practice of Infectious Diseases. 2000.)" And, once gone, these friendly bacteria are replaced by hostile bacteria such as Pseudomonas, Clostridium, and Klebsiella, and by Candida yeast, a powerful member of the fungi family.
So, we have the good and the bad regarding our chemical friends known as antibiotics. They can "save the day" at times, but they have ruined them at others -- just ask any woman with a yeast infection or look at any baby who suffers from thrush. You should know that, even should you just say "no" when your doctor moves to prescribe antibiotics for you, theoretically speaking you may still be taking them with every bite of steak and pork you eat.
That’s because more antibiotics per pound are used on livestock than in human medicine. How much of those antibiotics are passed on is difficult to determine, but the mere possibility of this kind of thing is certainly a worry.
Our goal in this book is to educate you and to help you make informed decisions. Some final, simple tips follow:
Despite our best efforts, most of us will get sick at some point and decide to go see a doctor. If you are a stubborn, married man, your wife will likely make the appointment for you.
If your questions annoy your doctor, then get another doctor. After all, you pay the bills, either directly or out of your paycheck in the form of insurance, and you deserve adequate treatment. On the other hand, if you feel you, in fact, do need an antibiotic and your doctor disagrees, try to work a deal in which she will prescribe an antibiotic for you if you don’t feel better in a couple of days. I learned an important lesson about this kind of disagreement during college, on a visit to the infirmary. The doctor there refused to give me an antibiotic for a URI I’d come down with. I had to suppress my anger at what I saw as arrogance on his part, but lo and behold, he was right. I got better without the pills I’d been sure I’d needed. I think a lot of people tend to underestimate their bodies’ healing abilities, in much the same way as I did. That’s just one reason why doctors are oftentimes in a better position to make the call as to whether or not to prescribe.
As far as chronic sinus infections go, Johns Hopkins researchers are now saying most such conditions are caused by a fungus. So, if you do have chronic sinusitis, stop taking antibiotics, get on an antifungal diet, and ask your doctor for antifungal medications. If your doctor refuses, visit a health food store for natural, off-the-shelf antifungals such as olive leaf extract, garlic, and Caprylic acid.
Once you improve, make sure you go back and let your doctor know how things worked out. Chances are she is neither experienced nor comfortable with prescribing antifungal medication. Your story may convince her to do her own research, the first step to changing her treatment philosophy.
It shouldn’t be too difficult to convince your doctor to let you try a prescription of nystatin. As one of the better gut antifungals, nystatin is also remarkably safe and free of side-effects.
If you’ve decided to go ahead and take an antibiotic:
I should tell you that, in my clinical practice years, many of my patients made great strides against acne through taking nystatin and a change in diet alone, without the antibiotics.
One, last note: Please ignore advertisements that recommend guzzling orange juice for the vitamin C it contains. A big dose of sugar is what you’d actually be getting. I have heard more than a few patients note that once they felt they were coming down with something, they immediately began downing glass after glass of orange juice, only to get even sicker. They concluded that they must not have caught the illness in time, which couldn’t have been any further from the truth.
The truth is, they simply fueled the fire of their infections with lots of sugar, all because they trusted a corporation’s advertisement to educate them about proper healing strategies. If you want that much vitamin C, you will be perfectly fine taking it in the 1,000 mg pill form a few times a day. As far as fluid requirements are concerned, your body is 70 percent water -- and that is exactly what it needs!