SCOTT EMERSON, MD

There is no question that ever since penicillin was discovered by Alexander Fleming in 1928, that antibiotics have been used to save countless lives combating infectious diseases. In fact, most persons reading this have experienced the power of thoughtful and responsible use of physician prescribed antibiotics in the past to rescue them from serious infections and even death.

But as time has passed over the last nine decades, thoughtless, irresponsible, misuse and over use of antibiotics has led to the selection and emergence of widespread antibiotic resistance by many pathogenic bacteria. Reasons for the antibiotic resistance crisis does include some over prescribing by physicians, but most importantly has resulted from widespread additions of antibiotics to the food of animals being used for factory farm meat production. This now poses a global threat to modern medicine’s achievements and is a growing public health problem.

Initially, before growing awareness of our gut microbiome’s central importance as a vitality organ in the body, antibiotics were thought to be only beneficial for patients, with very little downside risk. But multiple recent studies over the past decade have illuminated the disruption of the friendly bacteria of our gut microbiome from even thoughtful, appropriately targeted use of antibiotics.

Our normal gut microbiome contains an average of 40 to 50 trillion bacteria and is very complex with a diversity of at least 1000 different species. These microbes are always producing a vast array of very beneficial biochemical products that we cannot produce on our own. The microbiome is the control panel operator for our immune system, setting the balance of inflammatory and anti-inflammatory states and the set points of immune surveillance in our bodies.

Use of common antibiotics like erythromycin, cephalosporins, or tetracycline leads to rapid development of gut dysbiosis with the normal diversity of the gut microbiome markedly reduced and commonly resulting in antibiotic associated diarrhea ( Maier et.al., 2021 & Ramirez et. al, 2020)

This opens an ecosystem niche for overgrowth of pathogenic gut bacteria like Clostridium difficile and development of increasingly common and severe C. diff Disease. Long-term effects of antibiotics include creation of a leaky gut, immune imbalance, chronic inflammation, and a long list of subsequent chronic disease states. Although there is some ability of the gut microbiome to rebalance itself after a brief course of antibiotics, prolonged use or repeated courses greatly increase the likelihood of a permanent dysbiosis.

The use of any medicine is always associated with benefits and risks. So, how can we protect our normal gut microbiome from collateral damage risk during the time we need to take antibiotics, and rehab it afterward?

1. Regular exercise like brisk walking an hour a day with an occasional more intense work-out has been shown to correct imbalances and increase diversity in your gut microbiota very quickly (Ohad et. al., 2020). Ask your physician that prescribed the antibiotic if its OK to begin or continue moderate daily exercise while on your antibiotic course, and (or) after completion.

2. Increase your consumption of fermented foods like kimchi, sauerkraut, and tempeh while on antibiotics. These foods offer the trifecta of prebiotics, soluble fiber food supporting beneficial bacteria, and, probiotic alive good guy Lactobacillus bacteria and it’s metabolically produced postbiotic products like short chain fatty acids that support your intestinal cells.

3. Take bacterial probiotic supplements, administered ideally at least 2 to 3 hours after you have taken your antibiotic pill daily while on an antibiotic course. Look for a probiotic supplement that has good independent reviews, contains at least 15 different probiotic species, and at least 50 billion colony forming units (CFUs) per capsule. Take a daily dose of 100 billion CFUs while on the antibiotic course, then decrease to 50 billion CFUs daily for several weeks after completing the antibiotics, then stop. Beneficial bacterial probiotic supplements will likely be killed if taken at the same time as an antibacterial antibiotic, but if taken several hours after the antibiotic pill will likely survive a safe passage to the large intestine where biofilm formations may protect them. This serves as reinforcements for beneficial bacteria taken out by the antibiotic.

4. Take the probiotic yeast supplement, S. Boulardii CNCM I-745 strain, 10 billion CFUs (500 mg capsule 1 to 2 times a day) with your antibiotic pills, then stop once you have completed the antibiotic. This strain of wild tropical yeast has been well documented to greatly decrease the development of dysbiosis and antibiotic associated diarrhea from antibiotic use. It creates the protective nature of the normal healthy gut flora while you are taking antibiotics. It holds the ground against pathogenic colonizer bacteria. It is very safe, does not colonize the intestine, and is completely eliminated within 3 days of stopping the supplement. However, it should be avoided if you are immune-compromised from drugs or have an indwelling central venous catheter.