Is a shorter course of antibiotics OK? + Genetic risk of fibromyalgia

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Science Friday 17 min 1 speaker 8 chapters transcribed 3 days ago
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Why might a shorter antibiotic course be safer than the traditional full course?

Flora Lichtman 0:02
Hey, it's Flora, and you're listening to Science Friday. You've probably been warned that you'd better finish that course of antibiotics because if you don't, you could find yourself battling antibiotic resistant bacteria. Well, guess what? Apparently there is more to this story. In fact, a growing body of research suggests that the exact opposite might be true. So what does this mean for you and your next sinus infection? Here to tell us more is Dr. Amy Mathers, Medical Director of Antimicrobial Stewardship and an associate professor of medicine and pathology at the University of Virginia. Amy, thanks for being here. Thank you, Flora. Thanks for having me. Okay, this seems like a big shift from what I have always heard.
Amy Mathers 0:49
Yeah, so there was this dogma that finish the course or you will develop resistant bacteria. And it comes from long ago before we really understood how resistant bacteria worked. Not finishing the course sometimes would cause relapse. However, what we now understand is that a lot of relapse infections that were assumed to be because of resistant bacteria were actually more complicated than that. They may be a new infection, or they may have been that the first infection didn't get completely cleared out. But it didn't necessarily mean that. The bacteria was resistant. For example, strep that causes strep throat. Doesn't have any resistance to penicillin, and that's never been described. So it's not resistance that's driving it.
Amy Mathers 1:37
It's something else if you have a relapse.
Flora Lichtman 1:41
You know, I thought the logic was that if you don't take the full course, you might not fully wipe out the bacteria causing the infection and then the ones that weren't eliminated. are ones that are likely to have to be resistant to that antibiotic and then they could, you know, go forth and multiply.

How does the duration of antibiotic treatment affect gut microbiome and resistance?

Flora Lichtman 1:59
So what's wrong with that picture?
Amy Mathers 2:02
You you're on the right track for sure because what happens is is antibiotics actually target the infecting organism, but they also target a lot of other stuff and flora. And so the only bacteria that are left flora,
Flora Lichtman 2:18
like microflora. Yeah, like
Amy Mathers 2:19
microflora, like healthy bacteria that live in your gut that use up nutrients and probably don't carry resistance. And so when you expose all of those bacteria to an antibiotic, you may wipe all of those out, leaving behind only the resistant. organisms. And so the next time you have an infection. If you get a new infection Say In your bladder, in your sinus, it may develop resistance to antibiotics the next time you try to treat it. So you're not actually wrong. The issue is is the longer you're exposed to them, the more you're getting rid of that healthy flora and selecting for resistant bacteria. So what a lot of people and a lot of clinical trials have been doing lately is seeing what the shortest course possible is.
Amy Mathers 3:10
to decrease the collateral damage while still treating the infecting organism effectively.
Flora Lichtman 3:17
So the upshot here is that a longer course of antibiotics might actually make you more likely to develop uh antibiotic resistant bacteria inside of you.
Amy Mathers 3:26
That is correct. The the longer you're on the antibiotic, the more Selective pressure you put on your microbiome, and therefore the more likely you are to have resistant bacteria.
Flora Lichtman 3:40
Have we measured that? You know, uh how much bacteria you lose after seven days versus fourteen days? So some of that
Amy Mathers 3:49
research is emerging and depending on the antibiotic and the situation, um not all of that's been filled out completely, but there is a dose effect, and some scientists have shown the longer you're on an antibiotic or the more broad spectrum the antibiotic. that may have a different impact on your gut flora. So some antibiotics that might be more targeted won't cause as much selection for resistance as other antibiotics and the duration we know makes a difference. It also can select for other

What do recent clinical trials suggest about the optimal length for common infections?

Amy Mathers 4:23
Infections such as C diff, which may be a A microbe that you select for when you kill everything else off. C. diff is is left behind and can cause a gut infection because your normal flora is not there taking up the nutrients.

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