Side effects of antibiotic therapy

We read too often personal testimonies – on forums or Facebook groups that deal with the topic – that talk about a systematic intake of antibiotics after an acute episode of cystitis.

Of course, those who use antibiotics have probably received indications from their doctors or urologists, although antibiotic prophylaxis is not usually recommended by cystitis experts as it is an ineffective, dangerous and counterproductive therapeutic approach.

Here are some important considerations regarding the side effects of a prolonged antibiotic therapy:

1) it masks the infection keeping the number of pathogenic bacteria low

After an antibiotic intake, urine culture will obviously give a negative result. In fact, the antibiotic kills (or rather tries to kill) without distinction all bacteria that are sensitive to it. In the case of recurrent cystitis, if the quantity of bacteria is 10ml per ml for example, antibiotic intake will reduce them without, however, completely eradicating them. And even a single bacterium present in the bladder can trigger cystitis, even after only 12/24 h.

The antibiotic intake will therefore be a temporary solution after which the urinary infection will probably emerge stronger than before.

2) it also has side effects on bladder and urethra mucous membranes

The antibiotic certainly kills the bacteria, but in doing so, it causes them to release toxins that have an irritating effect on the mucous membranes. Since the urothelium is already damaged by infection, the very action of the antibiotic will increase the inflammation of the walls, contributing to the persistence of pain and will favor the installation of bacteria in the deeper layers of the mucosa.
The antibiotic therefore, throughout the duration of its intake, contributes to maintain and even increase tissues inflammation.

3) it destroys the physiological flora

The antibiotic does not select the bacteria to be eliminated: it is a real “bomb” that systematically kills almost all the bacteria that are sensitive to it.
This results is a very minor side effect: the damage (partial or total if the intake is prolonged) of the physiological flora with consequent:

– intestinal dysbiosis:
transit disorders (diarrhea, meteorism, constipation, nausea)
severe lowering of body’s general immune defenses
risk of developing a digestive mycosis that is difficult to fight (candidiasis)

– vaginal dysbiosis:
risk of vaginal mycosis
risk of vaginal infection (Gardnerella)
vaginal inflammation (vaginitis)
vaginal dryness that can make the intercourse painful (dyspareunia)

4) prolonged intake promotes antibiotic resistance

The antibiotic, as we mentioned before, kills the bacteria that are sensitive to it. If even a single bacterium has undergone a mutation that makes it insensitive to the antibiotic in question, then this will survive and multiply to give rise to a new colony of even more resistant bacteria.
Subsequent antibiotic intakes will then act as a sort of “natural selection” favoring the strongest bacterial strains and allowing them to install themselves permanently.

5) it is totally ineffective on biofilms

Biofilms are mucopolysaccharidic structures produced by bacteria themselves that act like a real armor, impenetrable to external attacks. In this way, bacteria survive undisturbed in the bladder, without fear of being reached and attacked by “enemy” agents such as immune defenses, antibiotics (precisely), but also by D-Mannose or other molecules.
Furthermore, biofilm behaves like a real “bacterial reserve” which, opening periodically, will let new bacteria our, ready to colonize the surrounding environment (in this case, the bladder).
The subject will therefore think of suffering from recurrent cystitis when, in reality, it will be the same infection that recurs.

Three things must be noted:

– biofilms are present in 60-80% of infectious diseases. This percentage increases in pathologies such as cystitis
– the period of maturation of the biofilm (ie the period between two episodes in which bacteria are released) can vary from a few hours to several months. It has not yet been established whether there are external factors affecting this cycle, but clinical experience reveals that periods of particular sensitivity of the subject (stress, cold, illness, surgery, lowered immune defenses, etc.) can actively influence on the frequency of these events.
– within the biofilm, different bacterial species can coexist (sometimes also fungal species). For this reason, urine culture tests can give different results, detecting an alternation of species or bacterial strains thus making the specialist diagnosis on the origin of the infection even more difficult.

Antibiotics intake is therefore effective only external bacteria to the biofilm (or better, only on a part of them). It has no disintegrating action against the biofilm and doesn’t eliminate the trigger of urinary infection.

6) it is not as effective as one tends to believe

Some antibiotic therapies are prescribed with a dosage that does not take into account the dynamics of action of the medicine used; after taking them, they are eliminated – renal or hepatic pathway – with a different speed depending on the molecule type. Some antibiotics have a duration of action of only 48 hours, for example. After this time, bacteria start to proliferate freely.

It is therefore advisable to make sure that the prescribed molecule corresponds to the real need of the patient and that it effectively contrasts bacteria life and reproduction cycle without leaving “uncovered areas”, from the biological point of view and from the temporal one.

For example: Monuril is not enough to cover a whole week and only after 3 days, the risk of relapse is high as if no medicine had been taken.

7) its risks/side effects are definitely undervalued

Antibiotic poisoning is a real and partly undervalued danger. In general, the oral intake of any substance, obviously involves a process of metabolization and then elimination. Our body has two large organs that ensure this elimination: liver and kidneys. When the waste to be eliminated is produced in a physiological way and in normal quantity, the eliminating organs do not suffer from it. On the other hand, if the waste produced is not physiological, as in the case of antibiotics intake, and if it is in large quantities, as in the case of prolonged intake, then the risk of hepatic or renal overload exists. Furthermore, antibiotic intoxication often has consequences on organs functioning.

All of this leads to recommend extreme caution in the use of these therapies which have a strong impact on our body to which it is only right to resort after having evaluated every other available strategy and whose administration must be carefully evaluated by the doctor.

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