On the trails of antibiotics

Mag. Julia Wild

The discovery of antibiotics was a major milestone in the history of medicine. Numerous diseases, which were previously incurable, suddenly became easily treatable. However, the disadvantages of taking antibiotics can be that they cause diarrhoea and lead to the creation of antibiotic resistant bacteria. They also destroy important gut bacteria which can further worsen these problems.

The discoverer of penicillin, Alexander Fleming, owes his fame to a fortunate coincidence: In 1928 he left his Lab in Londons St. Marys Hospital for his summer holidays. He forgot one of his culture plates which was full of pathological bacteria. When he came back he found that a mould fungus was growing in this Petri dish. However, the fascinating thing was that the bacteria hadnt been able to grow near this fungus. Fleming named this bactericidal fungus Penicillin. However, he didnt think to use it as a medicine.

 

Big steps towards success

A whole decade later the scientists Ernst B. Chain, Howard Florey, and Normal Heatley became interested in Flemings Penicillin. They were not only able to isolate the active substance, they also discovered its potent effect on gram-positive bacteria. It was 1941 when physicians used it as a treatment for the first time. The patient had suffered but a tiny cut to the finger, which had then led to blood poisoning. In just a few days after treatment with penicillin, the patients condition improved drastically. As soon as the patients fever subsided the doctors ended the therapy with penicillin because at the time, they didnt have a lot of the substance. This turned out to be a grave mistake, as the patient died shortly after they stopped giving the antibiotic. However, this led the scientists to the conclusion that to heal someone completely, this substance must be given for longer than the period of symptoms. Shortly after their discovery, Florey and Heatley travelled to the United States of America, to make the miraculous effect of penicillin public. In the year 1942 the industrialised production of this pharmaceutical began. To begin with it was primarily used to treat wounded soldiers in warzones. It was not until 1944 that the civilian population began to benefit from the antibiotic. It was soon available in every pharmacy. In 1945, Alexander Fleming, Ernst Chain and Howard Florey received the Nobel Prize for their sensational discovery. To this day, penicillin still represents the basis for a large part of our antibiotics. 

“Nowadays it is known that the application of antibiotics completely destroys some bacterial strains in the gut and that these cannot regenerate by themselves.”

The drawback: resistance

In Flemings Nobel Prize acceptance speech, he already delivered a warning concerning the use of his discovery: The time will come, when anyone can buy penicillin. This will harbour the danger that uninformed people will use penicillin in too small doses. By exposing the bacteria to a non-lethal dose, this person is making them resistant. The scientist was right: nowadays, per year, up to 700,000 people die of infections caused by so-called multi-resistant bacteria. Because of their antibiotic resistance, there are no antibiotics which can kill them. The root of this problem lies in the frequent prescription of broad-spectrum antibiotics. These antibiotics can kill many different types of bacteria at once. Anita Frauwallner, the director of Institut Allergosan and an expert in gut health explains the issues caused by antibiotic intake: When a physician suspects a patient is suffering from tonsillitis, this patient will typically be prescribed an antibiotic against bacteria of the staphylococcus genus. However, oftentimes the disease isnt actually caused by the germ that the physician assumed. Consequently, the antibiotic doesnt have an effect on the disease. It does however, have a negative effect on good, healthy bacteria in the gut and teaches other pathogenic bacteria how to protect themselves against the prescribed antibiotic substances. It is especially problematic when several different antibiotics are taken in rapid succession. With time this leads to the development of multi-resistant pathogens. If these begin to overrun the body, they may lead to very serious diseases.

 

Attacking important gut bacteria

Nowadays it is known that the application of antibiotics completely destroys some bacterial strains in the gut and that these cannot regenerate by themselves explains Frauwallner. Because every bacterial strain has its own specific properties, the loss of strains may mean that some body functions may no longer work as intended. For example, vitamin K cannot be supplied sufficiently via our normal diets. Specific bacteria must handle this for us; bacteria such as Lactococcus lactis. It is involved in the production of the necessary vitamin K, a vitamin which is essential for blood clotting and the heart. Especially in winter, people take antibiotics more frequently and repeatedly, says the gut specialist. Say if, like in the aforementioned example, a case of tonsillitis is treated with antibiotics. This is an important measure in the fight against the involved germs, but it also weakens the immune system. Therefore, its not unlikely that after this antibiotic-bombardment a person may develop a different infection, such as a urinary tract infection. And yet again, this new infection needs to be treated with antibiotics. This leads to a total meltdown for the gut flora, which in turn weakens the entire organism and ultimately promotes the development of resistant pathogenic bacteria. Some of these have become so resistant that there is no effective therapy to treat them.

 

Diarrhoea as a side effect

Diarrhoea is one of the most common adverse reactions when it comes to antibiotic therapy and is commonly referred to as antibiotic associated diarrhoea (AAD). It depends on the applied antibiotic whether someone will suffer from AAD and how severe the symptoms will be, says Frauwallner. Not every antibiotic will frequently cause diarrhoea. Some preparations even directly lead to an inflammation of the gut mucosa. Subsequently the gut begins producing fluids to try to heal itself; diarrhoea develops. It becomes dangerous when germs such as Salmonella or Clostridium difficile rapidly proliferate in the gut and so drive out the guts essential bacteria. This can quickly become life threatening. According to the expert, every person has around 10% pathogenic bacteria in their guts. Under normal circumstances, this does not affect healthy people. However, when antibiotics disrupt the guts equilibrium, these pathogenic germs suddenly have enough space to multiply and wreak havoc. 

 

Therapeutic approach: “a gut feeling”

Hence, the microbiome is a promising starting point to regulate inflammation in the gut and to strengthen the intestinal barrier, which prevents the infiltration of toxins that would cause inflammation in the whole body. A recent study concerning patients suffering from migraines shows that specific bacterial strains can reduce the frequency and intensity of migraine attacks. This meant the patients could reduce their necessary pain medication. The development of this innovative therapy was made possible due to the knowledge of how harmful substances enter the body via the gastrointestinal tract: The blood is enriched with nutrients when it passes through the gut. However, if the gut becomes permeable for harmful substances, these also enter the bloodstream and are transported to the liver via the portal vein. Our most important detoxification organ then cleanses the blood of toxins and other harmful substances. However, the liver has a limited performance capacity: If a leaky gut absorbs too many harmful substances, at some point these can no longer be fully broken down by the liver and can so enter the body via the blood circulation. These toxins may then reach as far as the brain, where they trigger various irritations. The brain possesses an efficient defence system: microglia cells. In a way, these act as a waste disposal and eliminate these toxins. However, the microglia cells can only mature if the gut microbiome is as diverse as possible and its bacteria produce enough short chain fatty acids such as butyrate. In a way, the reduction of the microbiomes diversity leads to a double vicious cycle: First, the function of the gut barrier cannot be fully maintained. More harmful substances penetrate the body and reach as far as the brain. In the brain, due to a loss of gut bacteria, the microglia cells can no longer fulfil their function because they are receiving too little butyrate to fully mature and become active.

 

“Just smile again…”

Non-steroidal anti-inflammatory drugs (NSAIDs, a group of anti-inflammatory painkillers) and triptans are typically used for the acute therapy of migraine. Medications such as beta blockers or anticonvulsants are used for the long-term prevention of migraine attacks. Anita Frauwallner: The intake of these medications can induce heavy side effects such as arterial hypertension, seizures, dizziness, persistent headache, or sensory dysfunctions. Andreas Straube: It becomes especially problematic when patients begin suffering an increased number of attacks each month. The resulting increased painkiller intake can quickly become dangerous: These medications can damage the gut and lead to higher blood pressure levels. When patients take them on a regular basis, they may also cause medication overuse headaches.

The intake of a high number of various bacteria (e.g. the multispecies probiotic OMNi-BiOTiC® 10 AAD) is especially effective against diarrhoea caused by antibiotic therapy.

OMNi-BiOTiC® 10 AAD
OMNi-BiOTiC® 10 AAD

Probiotics strengthen the good bacteria

Anita Frauwallner recommends already starting with the intake of a high dose probiotic twice daily on the first day of an antibiotic therapy. A so-called multispecies probiotic contains specially selected bacterial strains: If there are too few good bacteria in the gut, there is the danger that pathogenic bacteria may quickly multiply and overgrow the gut. The bacterium Clostridium difficile can be especially dangerous for children, elderly people and patients receiving chemotherapy. Therefore, a concomitant therapy with probiotics is essential in such cases. Imagine the gut is a sunbathing area at an outdoor pool. Without supporting probiotics, antibiotics remove the good bacteria from their sunbeds and so make them free for pathogenic bacteria. If one starts taking probiotics from the beginning of an antibiotic therapy, the pathogenic bacteria cant ever begin settling in the sunbathing area and are so kept at bay, compares Anita Frauwallner and emphasises the beneficial additional effects of probiotics: They not only protect the gut mucosa, they also protect the guts immune cells. This means that they improve a persons general well-being, just as much as they improve symptoms such as diarrhoea. It has been shown that the intake of a high number of various bacteria (e.g. the multispecies probiotic OMNi-BiOTiC® 10 AAD) is especially effective.

 

Studies show: probiotics work!

The collection of scientific data concerning the effect of probiotics have shown very good results, says Frauwallner: Scientific guidelines, more specifically the so-called Cochrane* report, confirm that probiotics have a safe and real effect in the prevention of antibiotic associated diarrhoea, as well as in the avoidance of the dangerous germ Clostridium difficile. In 2009, the World Gastroenterology Organisation (WGO) added Institut Allergosans study on the prevention and therapy of antibiotic associated diarrhoea with OMNi-BiOTiC® 10 AAD to their list of the 12 best studies worldwide. They did this because of its absolute seriousness and value for future research.

 

Treating something with something similar

The renowned scientist Prof. Reinhold W. Stockbrügger from the university of Maastricht in the Netherlands played a major role in the development of OMNi-BiOTiC® 10 AAD, says Frauwallner: Prof. Stockbrügger had many patients who landed in the intensive care ward because they suffered from serious Clostridium difficile infections caused by antibiotics. He wanted to help his patients, however, no medication showed an effect against the resistant germs. Thinking along the lines of homeopathy, he remembered the Law of Similars. Therefore, he contacted Institut Allergosan and asked if it would be possible to fight these bad germs with good ones. We tried just that, and our success proved us right. Modern medicine has become unimaginable without antibiotics. Thanks to the discovery of penicillin 88 years ago, infections such as pneumonia or tuberculosis can now be healed. However, powerful drugs often also cause adverse effects. Our present objective should now be finding natural substances, like probiotics, which can fight the devastating consequences antibiotics are having in our bodies. Anita Frauwallner summarizes: The goal is on the one hand the wiping out of pathological germs with antibiotics and on the other hand the strengthening of healthy bacterial strains with the help of multispecies probiotics.

*Cochrane is an international network which offers physicians, patients, and their representatives well established, evidence based decisions concerning healthcare and therapies.

www.austria.cochrane.org/de

Last updated: Tuesday, 15. January 2019

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