Antibiotics: Maximize Benefits, Minimize Intestinal Backlash

Posted 02/20/2012

Patients seem to be divided equally in their attitude toward antibiotics. Either they love ‘em, remembering relief from a painful bladder infection, a nagging cough, or clogged sinuses, or they hate ‘em, recalling minimal relief along with lots of diarrhea and/or an industrial-strength vaginal yeast infection.

That first group often progresses to what cultural anthropologists call “magical thinking.” Having seen the powerful results of antibiotics for Symptom A, they’ll request an antibiotic when Symptom B, C, or D makes itself known. They do this even though it’s a fact that most sudden-onset conditions–like sore throats and colds–are viral, meaning they’re caused by viruses that remain utterly indifferent to any antibiotic you take.

If you didn’t know, antibiotics work against bacteria and only bacteria.

Every so often, I’ll get a request from a real antibiotic enthusiast who’s had some nagging symptom for a while—for example, tiredness. The patient will request two or three antibiotics to be taken at the same time to “wipe out everything and start over,” a clean slate, so to speak, with the hope of re-introducing into his body “just those good bacteria” he’s been reading about.

You can imagine that every doctor, myself included, spends a lot of time talking people out of taking antibiotics. But magical thinking establishes itself deep in your brain and is hard to defeat. My game plan when dealing with an antibiotic request I deem inappropriate is to harken back to a rule I learned in med school: A viral infection will be gone in about two weeks using antibiotics. Without them, it will last 14 days.

The second group of patients, the antibiotic-phobics, understand how to treat viral infections appropriately, but press the panic button when they realize they might actually need an antibiotic. They’ll use all sorts of tactics to keep from taking it, most of which are just fine with me: neti pots and herbal blends for sinus infections; cranberry and vitamin C for bladder; inhalers, herbal teas, homeopathics, immune boosters.

Often these work well. The human body is pretty miraculous when it comes to ridding itself of unwanted invaders. But sometimes you’re stuck with a stubborn bacterial infection and, despite your best efforts, you need an antibiotic.

Here are five simple steps you can take to maximize the benefit from your antibiotic and minimize the risk of side effects:

1. Request an antibiotic with the narrowest spectrum of antibacterial activity and with the shortest treatment course. Narrow-spectrum antibiotics, like penicillin or azithromycin (Z-Pak), kill off only specific bacteria. They work well when your doctor has a good idea which bacterium is the likely culprit. Broad-spectrum antibiotics–the Rambo-mycins like Levaquin—should be reserved for more serious infections. However, antibiotic overuse in recent years has produced so many resistant strains of bacteria that the narrow-spectrum antibiotics are less and less effective. Whatever you’re prescribed, however, do take all the pills. Stopping early leaves behind the most robust, resistant bacteria and leads to the possibility your infection could return.
2. Food-wise, there are no restrictions when taking antibiotics. And although you might be tempted to take your meds with a meal to avoid stomach symptoms, in actual fact food (especially calcium-containing foods) blocks the absorption of several antibiotics. Others are best taken with food. “With or without food” should be stated clearly on the label. If not, ask the pharmacist. It’s important to stay hydrated, especially if you experience antibiotic-induced diarrhea. If you find yourself with an especially severe and persistent antibiotic-related diarrhea, call your physician. She may want you tested for C. Difficile, a bacterium that emerges during antibiotic use and which requires a second antibiotic to eradicate.
3. Start taking Florastor (saccharomyces boulardii), a strain of yeast–and hence not killed by your antibiotic–one capsule twice daily. We carry Florastor in our apothecary and it’s readily available in most drugstores. Using it will reduce your chances of getting antibiotic-induced diarrhea.
4. Also start on a good probiotic, which you must take 2 to 3 hours separately from your antibiotic dose. Two reasons for this: if you’re eating live-culture yogurt or kefir for the probiotic boost, the calcium in these foods can block antibiotic absorption. Additionally, the antibiotic will wipe out all those helpful bacteria if you take drug and probiotic at the same time.
5. If you know your body well enough to expect a vaginal yeast infection (candida) sometime after finishing your course of antibiotics, ask for a prescription for Diflucan (fluconazole) 100 mg. You can take a tablet once or twice daily for a few days after you’ve completed your antibiotic course. Use them only if you know you have a yeast infection—they won’t prevent one from occurring and, in fact, do just the opposite. With the combination of an antibiotic and Diflucan, you could develop a Diflucan-resistant strain of candida.

I’d urge you to read this story and knock out bacterial bugs with an antibiotic only when strictly necessary.

Be well,

David Edelberg, MD