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Experts have long emphasized that Poland is in the forefront of countries where antibiotics are abused. Unfortunately, their improper use can do more harm than good. We explain what rational antibiotic therapy is.
Anti and biostikos – what is an antibiotic?
Let’s start with what exactly are antibiotics? They are medicines that fight bacterial infections by killing the bacteria (bactericidal effect) or slowing or stopping their growth (bacteriostatic effect). The name itself was introduced in 1942 by the discoverer of streptomycin, Selman Waksman, who combined two Greek words anti (against) and biostikos (viable).
The way antibiotics work is different – they can attack the bacterial cell wall or the membrane surrounding the bacteria, interfere with bacterial reproduction, or block the bacteria’s production of protein.
Antibiotics are used primarily in the treatment of infections with pathogenic microorganisms, as well as prophylactically before surgery and in the prophylaxis of bacterial endocarditis. Importantly, there are specific indications for their use.
Unfortunately, like other drugs, antibiotics can cause side effects and interact with medicinal products, especially if we do not follow the principles of rational antibiotic therapy.
An antibiotic is a “double-edged sword”?
It is not without reason that this is said about antibiotics, which destroy not only pathogenic microorganisms, but also beneficial bacteria that inhabit our intestines and play a very important role in maintaining homeostasis (balance) of the body.
The importance of the intestinal microbiota is so great that in recent years it has gained the nickname of “superorganism”. Bacteria living in the digestive tract are responsible not only for digestion and absorption of nutrients and nutrients, but also participate in the synthesis of vitamins (K, B group) and the formation of short-chain fatty acids, which are the main source of energy for intestinal cells. In addition, they stimulate our immune system, stimulating the synthesis of mucins that have a protective effect on the intestinal epithelium.
Unfortunately, there are many factors that can lead to an imbalance in the gut, i.e. the amount, composition and function of the gut microflora. This condition is known as “dysbiosis” and one of the main causes is antibiotic therapy. Post-antibiotic dysbiosis most often occurs during antibiotic therapy and is associated with many adverse health consequences, both short-term and long-term.
As experts argue, the return to the state before antibiotic therapy and the normalization of the composition of the intestinal microbiota is a process lasting several weeks, sometimes months or even longer. It depends primarily on the patient’s age, microbiome composition, medications, diet, environmental and genetic factors.
“Harvest” of post-antibiotic dysbiosis
Abdominal pain, flatulence, increased intestinal peristalsis (intestinal colic in infants) are the first symptoms of post-antibiotic dysbiosis. However, one of the most common side effects of antibiotic therapy is a specific form of diarrhea called antibiotic-associated diarrhea (AAD), which is defined as a diarrheal syndrome that occurs during or up to 2 months after treatment with antimicrobial drugs, mainly antibacterials. It is estimated that this type of diarrhea may occur in more than 1/3 of people taking antibiotics.
And although post-antibiotic diarrhea is usually mild, in certain situations it may pose a threat to health and even life. Firstly, the accompanying ailments often lead the patient to arbitrarily discontinue antibiotic therapy before the infection is cured, which is synonymous with ineffective treatment and the risk of selecting resistant strains of microorganisms. Second, severe diarrhea may affect the pharmacokinetics of the antibiotic and other medications used by the patient. Thirdly, the severity of AAD may be so high that it poses a significant threat to the health of the patient, especially young children, the elderly, and patients in a poor general condition at baseline due to comorbidities.
Other conditions directly related to antibiotic therapy and post-antibiotic dysbiosis are mycoses of the gastrointestinal tract and the reproductive system.
Recent studies also indicate that post-antibiotic dysbiosis may have long-term consequences, including functional disorders of the gastrointestinal tract (IBS – irritable bowel syndrome) and chronic non-infectious diseases such as allergy, metabolic syndrome, obesity and diabetes.
Rational antibiotic therapy
Fortunately, the occurrence of post-antibiotic dysbiosis can be prevented, but one should remember about the principles of rational antibiotic therapy. First of all, we only use antibiotics when there are indications (e.g. viral infections are not treated with antibiotics), adhering to the recommendations regarding the duration of therapy and dosage. Secondly, we do not forget about the protection of the intestinal microbiota, in which probiotics (so-called good microorganisms) play a key role, which should be taken not only during but also after antibiotic therapy.
The impact of probiotics on the human body is primarily due to their ability to modulate the composition of the microbiota and protect against colonization by pathogens. Moreover, some of them exhibit specific activity against certain pathogens, as exemplified by a yeast strain Saccharomyces boulardii CNCM I-745, which produces enzyme proteins that break down the toxin A Clostridium difficile, as well as neutralizing such pathogens as E. coli, Clostridium difficile, Salmonella typhimurium, Yersinia enterolitica, Candida albicans, Candida krusei, Candida pseudotropicalis. Beneficial yeast Saccharomyces boulardii CNCM I-745 can be found in a universal drug for diarrhea and also a probiotic – Enterol, which can be used by both adults and children (including infants).
The beneficial effect of probiotic supplementation in order to prevent post-antibiotic dysbiosis is confirmed by clinical trials. It has been shown that the use of probiotics during antibiotic therapy reduces by 50%. risk of developing post-antibiotic diarrhea. ESPGHAN (European Society for Pediatric Gastroenterology, Hepatology and Nutrition) experts recommend administering the two best-studied probiotics from the first day of antibiotic therapy in children: Saccharomyces boulardii CNCM I-745 albo Lactobacillus rhamnosus GG. For the prevention of induced diarrhea Clostridium difficile recommend serving Saccharomyces boulardii CNCM I-745.
Details on the enterol.pl website
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