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Deer tick Credit: Wikipedia

Finally, some good news in the treatment of Lyme disease. A recent study found that treating with 2 or 3 antibiotics at once is more effective in clearing Lyme disease bacteria than just treating with a course of one antibiotic (which is what is done now). In other words, a combination therapy is superior.

A single course of antibiotics treats most Lyme disease infections, but not in about 10 to 20% of patients. Studies find that this is because the Lyme disease bacteria hide in the organs (the sneaky devils!). The Lyme disease bacteria (Borrelia burgdorferi) is transmitted by tick bites.

The study was done in mice with persistent Lyme disease, but the results also (probably) apply to humans with persistent Lyme disease infections. None of the single antibiotics completely eradicated the bacteria, but the following 4 dual combinations were effective: doxycycline + ceftriaxone, dapsone + rifampicin, dapsone + clofazimine, doxycycline + cefotaxime. Also effective were 3 triple antibiotic combinations: doxycycline + ceftriaxone+ carbomycin, doxycycline + cefotaxime+ loratadine, dapsone+ rifampicin+ clofazimine. The drugs were given for 28 days two months after infection.

Next step is testing this in humans with persistent Lyme disease.

From Medical Xpress: Combined antibiotics more effective against Lyme disease: Study

Researchers at Tulane University have found that a combination of antibiotics is more effective in treating Lyme disease than the commonly prescribed course of one single antibiotic. This finding, published in Frontiers in Microbiology, could pave the way for improved Lyme disease treatments, particularly in persistent cases that have not responded to standard antibiotic treatment. ...continue reading "Combination Antibiotic Therapy May Help With Persistent Lyme Disease"

Many studies show that antibiotics disrupt the gut microbiome (intestinal microbial community of bacteria, viruses, fungi) in adults, but what about infants? A recent study found alterations in the gut microbes of young babies from a single course of antibiotics, with an increase in fungal species. And 6 weeks later the gut microbial community still wasn't back to normal. Yikes.

Antibiotics can be life-saving, but they must be used carefully - only when needed. As research shows, when some microbes are killed off by antibiotics, then other microbes (e.g. fungi such as Candida) that are resistant to the antibiotics increase (multiply) and move into the vacated spaces. There are no empty spaces in the gut.

Babies normally have a variety of fungal species in the gut already at a very young age - and this community of fungi is called the gut mycobiota or mycobiome. The Univ. of Helsinki researchers concluded that normally bacteria control fungi numbers in the gut - there is balance of all sorts of microbes (bacteria, viruses, fungi). But if you kill off bacteria (with antibiotics), then fungi numbers increase - an example of an imbalance in the gut microbial community or dysbiosis.

From Science Daily: A single course of antibiotics affects the gut microbiota of infants

A study recently completed at the University of Helsinki revealed that the fungal microbiota in the gut is more abundant and diverse in children treated with antibiotics compared with the control group even six weeks following the start of the antibiotic course. In light of the findings, a reduction in the number of gut bacteria as a result of antibiotic therapy reduces competition for space and leaves more room for fungi to multiply. ...continue reading "Antibiotics Alter Gut Microbes In Young Infants"

Drawing of colon seen from front (the appendix is colored red). Credit: Wikipedia.

What a difference a few years makes in medical opinion in how appendicitis should be treated! Not routinely with surgery (appendectomy), but trying a course of antibiotics first.

Researchers from Duke University Medical Center reviewed studies and found that antibiotics successfully treat up to 70% of uncomplicated appendicitis cases. For this reason the researchers state that antibiotics should be tried first in uncomplicated appendicitis cases. And if needed (e.g., if there are recurrences of appendicitis) surgery can be done.

Back in 2015 a Finnish study found that antibiotics alone can treat the majority of cases of uncomplicated appendicitis in adults. No need for surgery. That same year another study was published finding antibiotics to be a successful treatment for uncomplicated appendicitis in children - and that at one year follow-up 75.6% of the antibiotics group had not had any recurrences of appendicitis.

This is a major shift in how to treat an ailment, and it happened quickly. Most people with appendicitis would definitely (probably) opt for a course of antibiotics rather than surgery and see if that works..

From Science Daily: Antibiotics can be first-line therapy for uncomplicated appendicitis cases

With numerous recent studies demonstrating that antibiotics work as well as surgery for most uncomplicated appendicitis cases, the non-surgical approach can now be considered a routine option, according to a review article in JAMA.  ...continue reading "Treating Appendicitis With Antibiotics"

Antibiotics can be life-saving, but there are also unintended consequences. One of them is that they disrupt and alter the gut microbiome (the microbial community of the millions of microbes living in the intestines). A large study found that use of antibiotics is linked to a higher risk of colon cancer 5 to 10 years later.

The researchers thought this was due to the antibiotics having negative effects on the gut microbiome. Antibiotics reduce numbers of beneficial bacteria in the intestines, while allowing bacteria linked to colorectal cancer to increase.

Researchers at Unea Univ. in Sweden compared 40,545 colon cancer cases to 202,720 controls (no cancer), and found that as antibiotic use increased, colon cancer increased in those persons during the next 10 years. It is unknown what happens after 10 years, because that is when the study ended. Interestingly, in women - increased use of antibiotics was linked to a lower incidence of rectal cancer.

The researchers analyzed the results with respect to different classes  of antibiotics, and found the strongest association with the use of quinolones, sulfonamides, and trimethoprims. These antibiotics have an effect on bacterial diversity - specifically allowing anaerobic Fusobacteria and Bacteroidetes species to live and become more abundant. Other studies also support the view that Fusobacteria (e.g., Fusobacterium nucleatum) and Bacteroidetes species contribute to colorectal cancer development.

What to do? To increase beneficial species in the gut and lower levels of inflammation in the body, studies support eating a diet rich in fruits, vegetables, whole grains, nuts, seeds, legumes, and fish - which also results in a high fiber intake (e.g., Mediterranean diet). Also, to quickly improve the diversity of microbes in the gut (a sign of health!) and to lower inflammation in the body, increase your intake of fermented foods.

Fermented foods include: yogurt, buttermilk, sour cream, cheese, kefir, fermented vegetables, kimchi, natto, miso, sauerkraut, traditional pickles, traditional sourdough bread, apple cider vinegar, and kombucha. To quickly improve the gut microbiome, try to eat six 1/2 cup servings each day for a few months.

From Science Daily: Antibiotics linked to increased risk of colon cancer

There is a clear link between taking antibiotics and an increased risk of developing colon cancer within the next five to ten years. This has been confirmed by researchers at Umeå University, Sweden, after a study of 40,000 cancer cases. The impact of antibiotics on the intestinal microbiome is thought to lie behind the increased risk of cancer.  ...continue reading "Antibiotics and Colon Cancer"

Well, the following findings make total sense. A recent study found that organic meat (beef, pork, chicken, turkey) is less likely to be contaminated by harmful bacteria, including multidrug resistant bacteria. These findings hold even if it is processed in a place that also processes non-organic (conventional) meat. But the best results are if organic meat is processed at a processing facility that only handles organic meat.

One interesting finding was that the type of meat processing facility also mattered. Conventional meat that is processed by a "split-processing" facility (processes both organic and conventional meat) had lower rates of multidrug resistant bacteria contamination than processing facilities that only handle conventional meat. This could be because disinfection has to take place in-between processing of organic and conventional meat batches.

This antibiotic use and resistant bacteria association has been known for years for both humans and animals. If antibiotics and other antimicrobials are avoided whenever possible, then bacteria are less likely to mutate, and there is a lower incidence of multidrug resistant microbes.

Bottom line: try to eat organically grown meat whenever possible. It's better environmentally and better for health.

From Science Daily: Organic meat less likely to be contaminated with multidrug-resistant bacteria

Meat that is certified organic by the U.S. Department of Agriculture is less likely to be contaminated with bacteria that can sicken people, including dangerous, multidrug-resistant organisms, compared to conventionally produced meat, according to a study from researchers at the Johns Hopkins Bloomberg School of Public Health.  ...continue reading "Organic Meat Less Likely To Be Contaminated By Harmful Bacteria"

Everyone is concerned with the problem of antibiotics not working due to antibiotic resistance, that is, when bacteria resist the effects of antibiotics. Researchers typically study genetic changes that occur in bacteria over time, but researchers at Newcastle University in the UK found evidence for a another reason that antibiotics may not work in treating an infection. They found that bacteria can change shape and shed their cell walls, which are their outermost defense and the primary target of most antibiotics. Then when the antibiotics are stopped, they can go back to their original shape. Sneaky!

The researchers suggest that in the future we may have to treat infections with combined antibiotics, that is use antibiotics that kill bacteria with cell walls and also antibiotics that kill bacteria forms without cell walls (called L-forms).

Excerpts from  the study researcher Katarzyna Mickiewicz's post in The Conversation: Antibiotic resistance: researchers have directly proven that bacteria can change shape inside humans to avoid antibiotics   ...continue reading "Antibiotics May Not Work If Bacteria Change Their Shape"

A really interesting study found that in humans, taking antibiotics (which reduces the gut bacteria) may result in the flu vaccine not being as effective as in people who did not take antibiotics. An earlier similar study had found that this was true for mice, which is why the researchers did the study on humans.

The Stanford University and Emory University researchers studied healthy people who had recent (in last few years) flu vaccinations and those who hadn't had a flu vaccine for several years prior to the study. Some individuals took 5 days of broad spectrum antibiotics, and on day 4 received a flu vaccine, while others did not take antibiotics, but did receive the flu vaccine on day 4.

Not surprisingly: The antibiotics lowered the gut-bacterial population by 10,000-fold. While month by month there was increasing recovery, the resulting loss of overall diversity was detectable for up to one year after the antibiotics were taken. Keep in mind that they found that: "Notably, species richness and biodiversity were not fully recovered at 6 months, indicating long-lasting loss of unique bacterial species, consistent with previous studies." [BOTTOM LINE: Only take antibiotics when necessary.]

Interestingly, after antibiotic use, the researchers found other changes besides an alteration in gut bacteria populations. They also found changes within the immune system which resulted in an inflammatory state, which was due to "impairments in bile acid metabolism by the gut flora". In other words, taking antibiotics has a number of effects beyond treating an infection (the reason they were taken).

By the way, those who had taken flu vaccines in prior years had much better responses to the vaccines - they only had a minimal impact on vaccine response, even though they took antibiotics, than those who had not. Those who had not received flu vaccines or the flu in recent years had "low preexisting immunity", and taking the antibiotics (which resulted in loss of gut bacterial species) impaired their antibody response to the flu  vaccine. The researchers said: "The results of this study are consistent with the concept of immune responses in adults being largely determined by immune history and resilient to transient changes in the microbiome."

From Medical Xpress: Individual response to flu vaccine influenced by gut microbes   ...continue reading "Antibiotics, Flu Vaccines, and Gut Bacteria"

The issue of antibiotic resistance, that is, of antibiotics no longer working for bacterial infections in humans is a huge concern. So why are we squandering the antibiotic oxytetracycline on orange trees sickened with the disease citrus greening when a recent study by University of Florida researchers says it doesn't work?

The US Environmental Protection Agency gave permission for large-scale agricultural use of 2 antibiotics (streptomycin and oxytetracycline) to try to combat the bacterial infection that is destroying vast numbers of orange trees in Florida, Texas, and other states. However, the 2 antibiotics are also used to treat a number of bacterial infections in humans. And the latest development is that a study found that when oxytetracycline was sprayed on citrus trees for 6 months according to manufacturer's directions, it was no more effective than spraying water against the harmful bacteria (Candidatus Liberibacter asiaticus). 

Public health advocates, the FDA (Food and Drug Administration), and the CDC (Centers for Disease Control and Prevention) were all opposed to the EPA's antibiotic approvals for the citrus tree disease. They are very concerned that such large scale use could result in the development of antibiotic resistant bacteria, thus making these antibiotics useless in treating human illnesses. The CDC states that each year in the U.S., at least 2 million people get an antibiotic-resistant infection, and at least 23,000 people die.

Keep in mind that the European Union has banned the agricultural use of both oxytetracycline and streptomycin. Brazil has also banned these 2 antibiotics for agricultural use, and there citrus growers are battling the same citrus greening bacteria in citrus groves.

Steven Roach, a senior analyst for the advocacy group Keep Antibiotics Working has said:  “To allow such a massive increase of these drugs in agriculture is a recipe for disaster. It’s putting the needs of the citrus industry ahead of human health.”

From the NY Times: Spraying Antibiotics to Fight Citrus Scourge Doesn’t Help, Study Finds   ...continue reading "Time to Reassess Spraying Antibiotics On Orange Trees"

Many, many people wind up taking numerous courses of antibiotics at some points in life. Think of recurrent sinus infections or urinary tract infections or other infections. Or some conditions (e.g. dental or skin conditions) are treated with really long courses of antibiotics  New research (from 36,429 women participating in the long-running Nurses' Health Study)  found that women who take antibiotics over a long period of time during middle-age (40 to 59 years old), but even more so in late adulthood (60 years and over), are at increased risk of heart attack or stroke within the next 8 years.

How increased a risk for cardiovascular diseas? 28% or higher risk (compared to those who didn't take antibiotics)! But looking at the actual numbers it means: Among women who take antibiotics for two months or more in late adulthood, six women per 1,000 would develop a cardiovascular disease, compared to three per 1,000 among women who had not taken antibiotics.

Eight years was the length of the study, so it is unknown if the increased risk persists longer. The authors give a number of possible reasons for these results, but think it might be because antibiotic use results in gut microbial alterations. And the longer the antibiotic use, the more persistent the gut microbiome (microbial community) alterations. Other research studies supports this link (antibiotic use - gut microbe disruptions - increased cardiovascular disease). Another reason to eat in as healthy a manner as possible to feed beneficial gut microbes: a diet rich in fruits, vegetables, whole grains, seeds, and nuts.

From Medical Xpress: Antibiotic use linked to greater risk of heart attack and stroke in women

Women who take antibiotics over a long period of time are at increased risk of heart attack or stroke, according to research carried out in nearly 36,500 women. The study, published in the European Heart Journal today, found that women aged 60 or older who took antibiotics for two months or more had the greatest risk of cardiovascular disease, but long duration of antibiotic use was also associated with an increased risk if taken during middle age (aged 40-59). The researchers could find no increased risk from antibiotic use by younger adults aged between 20-39.  ...continue reading "Link Between Antibiotics, Heart Attacks, and Stroke Risk In Older Women"

Many people take probiotics in the belief that the probiotics will help their gut microbiome (microbial community) recover after taking antibiotics. This is because antibiotics kill both beneficial and pathogenic bacteria, and research shows it may take months for the gut to recover (it depends on the antibiotics taken). However, 2 studies (in both mice and healthy humans) conducted by a group of researchers at the Weizmann Institute of Science in Israel challenge that belief. The researchers used both mice and healthy humans in both well-done studies. They found that taking probiotics after a week of antibiotics actually delayed recovery of the gut microbial community in humans - months longer!

In summary: As expected, taking antibiotics had a big effect on the gut microbiome - the researchers wrote "a dramatic impact"  and "profound microbial depletion" (after taking one week of standard doses of "broad-spectrum antibiotics").  However, they found large differences among the 3 groups in gut microbial recovery after antibiotics. The spontaneous recovery group (they did not take probiotics after antibiotics) showed recovery of gut microbes within 3 weeks. The fecal transplant group (of their own fecal microbes which was collected before they took antibiotics) showed gut microbial recovery within 1 day of the fecal microbial transplant. In contrast, the group taking daily  probiotics for 28 days did not show full recovery (to where they were before antibiotics) by day 28, and the gut microbial community was still out of whack (dysbiosis) even 5 months after stopping probiotics (actually even at 180 days when the study ended).

What species were in the probiotics? Eleven species commonly found in ordinary probiotics: Lactobacillus acidophilus, L. casei, L. casei subsp. paracasei, L. plantarum, L. rhamnosus, Bifidobacterium longum, B. bifidum, B. breve, B. longum sbsp. infantism, Lactococcus lactis, and Streptococcus thermophilus.  These are all considered beneficial species. But keep in mind that the human gut has hundreds of microbial species - not just the few found in probiotics.

Bottom line: Eat well after taking a course of antibiotics so as to feed beneficial microbes, and do not routinely take probiotics thinking it will help the microbes in the gut.

What was also interesting was that in the first study where healthy individuals took the probiotics (and no antibiotics), they found that the probiotic species did not colonize the gut in everyone - only some species and in some people. It's as if there is a "resistance to colonization". This resistance is perhaps what other studies show - that within one week of discontinuing probiotics, they are gone from the gut.

From Science Daily - Human gut study questions probiotic health benefits  ...continue reading "Research Suggests Not Taking Probiotics After Antibiotics"