Explore this issue:July 2016
American Otological Society: The Hidden Cost of Antibiotics
Martin Blaser, MD, Muriel and George Singer Professor of medicine, professor in the department of microbiology, and director of the Human Microbiome Program at New York University School of Medicine in New York City, gave the Bluestone Lecture to the audience gathered at the American Otological Society Annual Meeting. In his talk, Dr. Blaser explained that treating ear infections with antibiotics may have hidden costs.
In the 1940’s, physicians were just learning how to defeat bacterial infections of the urinary tract, sinuses, and ears. The impressive cures of last century have evolved, over the years, into an extravagant use of antibiotics, especially in the treatment of common upper respiratory tract infections. Today, antibiotics are regularly prescribed, even though fewer than 20% of upper respiratory tract infections are caused by bacteria.
The situation is made more complex by the fact that four of the bacterial species frequently identified in upper respiratory tract infections (Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus, and Haemophilus influenzae) also colonize the upper respiratory tract of healthy individuals. Colonization by these microbes is generally a harmless event, and their presence is the sign of a healthy microbiome. Physicians are thus in the position of acting upon the evolving realization that our noses and throats are hosts to a microbiome that includes friendly bacteria that can also be pathogenic. This situation becomes even more complex as research reveals that these bacteria (for example, the viridans streptococci of the mouth) may actually help to maintain health by inhibiting potential pathogens and modulating the immune system.
Of course, potential respiratory pathogens cannot be ignored. They can cause serious complications such as mastoiditis and rheumatic fever. In many cases, however, concern about these worst-case scenarios leads physicians to prescribe antibiotics, even to children who would likely have no trouble recovering without the antibiotics. Prescription of antibiotics in these cases may disrupt the microbiome equilibrium without benefitting the patient. Dr. Blaser suggested that physicians should consider this hidden cost when prescribing antibiotics.
From the Audience
“Dr. Blaser gave further evidence that we need to be very judicious about the use of systemic antibiotics.” —Jeffrey P. Ludemann, MD University of British Columbia Vancouver