Most people have been prescribed and taken an antibiotic at some point to address an infection or illness. While antibiotics have significantly advanced medicine and the management of infectious diseases, overuse and overprescription are becoming global health concerns. Due to the emergence of antibiotic resistance and concerns about antibiotic-associated side effects, many are exploring natural options to support the immune system and manage bacterial infections. This article will discuss antibiotics, the potential side effects of their use, how to support the body when antibiotic therapy is indicated, and natural agents that may be used alongside prescription medications.
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What Are Antibiotics?
Antibiotics are a class of medicine that help manage bacterial infections in humans and animals. They work by either reducing the bacteria or impairing bacterial growth and division. Antibiotics can only address infections caused by bacterial pathogens. Common infections where antibiotics may be indicated include strep throat, urinary tract infections, many skin infections, ear infections, sinusitis, and bacterial pneumonia. Antibiotics are not effective for viral, parasitic, and fungal infections. (1, 4)
There are many different types of antibiotics, which are subcategorized into classes based on their chemical structure and mechanism of action. Common antibiotic classes include penicillins, macrolides, cephalosporins, fluoroquinolones, beta-lactams, and tetracyclines.
How Do Antibiotics Work?
Antibiotics can be broadly divided into two groups based on how they manage bacterial infections. Bactericidal antibiotics directly reduce bacteria, and bacteriostatic antibiotics suppress bacterial growth. (3)
There are five basic mechanisms of antibiotic action against bacteria:
Inhibition of Cell Wall Synthesis
Bacterial cells are surrounded by a cell wall made of peptidoglycans (a meshwork consisting of sugars and amino acids). Certain antibiotics, like beta-lactams, inhibit cell wall synthesis, which may lead to bacterial rupture. (2)
Inhibition of Protein Synthesis
Protein synthesis involves a process of DNA transcription to synthesize an RNA molecule called messenger RNA (mRNA). Then, a bacterial 70S ribosome structure synthesizes proteins from the information encoded in the mRNA in a process called translation. Antibiotics can inhibit bacterial protein synthesis by binding and inhibiting subunits of the bacterial ribosome. (2)
Alteration of Cell Membranes
Antibiotics that disrupt and alter the cellular plasma membrane cause rapid depolarization of the bacterial cell, which may lead to inhibition of protein, DNA, and RNA synthesis. (2)
Inhibition of Nucleic Acid (DNA) Synthesis
Nucleic acid inhibitors work through various mechanisms to disrupt bacterial DNA synthesis and replication. For example, fluoroquinolones are a class of nucleic acid inhibitors that inhibit bacterial enzymes required for DNA replication. (2)
Antimetabolite Activity
Antimetabolites inhibit distinct steps in folic acid metabolism, which may disrupt bacterial DNA synthesis. (2)
How Do Antibiotics Affect the Body?
All medications have the potential to cause adverse reactions. Common side effects related to antibiotic use include (5, 6):
- Digestive upset: nausea, vomiting, diarrhea, bloating, loss of appetite, abdominal pain, indigestion
- Rash
- Light sensitivity, especially when taking tetracyclines
Some antibiotic classes are associated with more unusual side effects, including (5, 6):
- Low platelet count: cephalosporins and penicillins
- Severe aches and pains, tendon rupture: fluoroquinolones
- Hearing loss: macrolides and aminoglycosides
- Kidney stones: sulfonamides
Many antibiotics are broad-spectrum, meaning they act to reduce a wide variety of bacteria. These antibiotics cannot distinguish between "bad" bugs and "good" bugs, so it is common for disturbances in the healthy microbiome to occur during and after a course of antibiotic treatment. This reduction in human microbiota diversity is responsible for general digestive side effects, antibiotic-associated diarrhea, and in more severe cases, Clostridioides difficile (C. diff) infection (characterized by severe, bloody diarrhea and intestinal inflammation). (7)
Antibiotic-mediated changes to the gut microbiome may lead to reduced gastric motility and impact the immune system's functioning. Reductions of beneficial bacteria and the disruption of immune function can predispose a person to develop fungal infections, commonly of the mouth, intestines, vagina, and skin. (7-9)
FAQ About Antibiotics
Below are answers to frequently asked questions about antibiotics and their use.
What is Antibiotic Resistance?
Antibiotic resistance occurs when bacteria adapt and evolve to evade the antibiotics designed to manage them. This results in difficult-to-manage infections, leading to extended hospital stays, higher medical costs, and increased mortality. (10)
Antibiotic resistance is a threat to global health. At least 700,000 people die annually from antibiotic-resistant infections, a number anticipated to increase significantly without any action to address the problem. The increasing rates of antibiotic resistance can be attributed to antibiotic overuse and misuse, agricultural use of antibiotics, and international travel. (10, 11)
Can You Drink Alcohol While Taking Antibiotics?
It is generally recommended to avoid drinking alcohol during antibiotic therapy. Alcohol can induce blood sugar changes, dampen the immune response, and prolong recovery from illness. Alcohol and antibiotics can cause similar side effects, like stomach upset and dizziness; combining alcohol and antibiotics can increase these side effects. There are certain antibiotics where alcohol should be explicitly avoided during treatment due to the increased risk of severe side effects. These include metronidazole, tinidazole, sulfamethoxazole/trimethoprim, and linezolid. (14, 15)
How Long Does it Take for Antibiotics to Work?
Several factors can impact the length of time it takes for antibiotics to start working, including the type of infection, class of antibiotic, and overall health status of the patient. Antibiotics begin to work as soon as you start taking them, although it might take 2-3 days before you start feeling better.
Do Antibiotics Make You Tired?
Fatigue is not a common side effect of most antibiotics; however, it is possible to feel more tired when you start taking them. This fatigue may be related to being sick, an interaction with another medication, or a die-off reaction. It is recommended that you speak with your doctor if you experience fatigue that affects your ability to drive safely or prevents you from performing daily activities of living.
Functional Medicine Labs to Test for Patients Worried About Taking Antibiotics
Functional medicine labs help practitioners personalize treatment options for their patients. Additionally, labs can help confirm bacterial infection, identify the causative organism, and determine the most effective antibiotic for treatment.
Basic Health Evaluation
A basic health evaluation with a complete blood count (CBC) and comprehensive metabolic panel (CMP) can show white blood cell patterns indicative of bacterial infection and ensure the liver and kidneys are functioning optimally to prevent antibiotic-associated adverse effects. Additionally, procalcitonin is an inflammatory marker that can easily be added to this panel. Elevated procalcitonin can differentiate between bacterial and viral infections, confirming that antibiotic treatment is appropriate.
Culture & Sensitivity
The key to safely and effectively managing bacterial infections with antibiotics is identifying the presence of a bacterial pathogen and the correct antibiotic agent to use. Culture and sensitivity can be performed on a variety of bodily fluids. This test cultures and identifies the pathogenic agent and then performs susceptibility testing on it to determine antibiotic agents that will and will not be effective in treatment. The type of culture you order will depend on the patient's symptoms and the location of the infection. Common cultures include stool testing for gastrointestinal symptoms, urinalysis for urinary symptoms, throat or sputum culture for respiratory symptoms, and vaginal culture for vaginal symptoms.
Comprehensive Stool Test
A comprehensive stool analysis can be ordered as an alternative to, or in combination with, traditional stool culture for a more in-depth analysis of the gut microbiome. The benefit of a comprehensive stool test is that it screens for pathogenic infections and assesses the healthy microbiome's health and composition. Identifying imbalances in the microbiome before starting antibiotic therapy can help patients proactively initiate and dial in probiotic treatment to support microbiome balance. Comprehensive stool tests also include natural antimicrobial agents in addition to pharmaceutical antibiotics on the susceptibility portion of the test.
Yeast Culture
Because antibiotics can increase the risk for and exacerbate yeast overgrowth, identifying and addressing preexisting fungal imbalances before and during antibiotic therapy may be beneficial. Commonly ordered tests to identify fungal overgrowth include stool cultures and Candida antibodies.
Natural Antibiotics & Their Comparison to Pharmaceutical Antibiotics
There are natural options that some people consider to support their health alongside or instead of pharmaceutical antibiotic therapy. The antimicrobial activity of plants depends on their constituents, including phenols, polyphenols, terpenoids, essential oils, alkaloids, lectins, and polypeptides. Because plant metabolites can support the body's natural defenses and may affect multiple bacterial sites, bacteria are less likely to develop resistance to herbal products. (12)
Some herbs have been found to have significant antibacterial properties. For example, a 2014 study found that herbal formulas containing Pau D'Arco, thyme, mugwort, yarrow, sage, oregano, and berberine (among others) were effective in supporting patients with small intestinal overgrowth (SIBO).
Some plant constituents with notable antimicrobial potential include berberine, piperine, eugenol, tannins, allicin, berberine, and thymol.
Studies also show that using herbal extracts in combination with prescription antibiotics may create a synergistic antimicrobial effect, potentially making therapy more effective and supporting efforts to manage antibiotic resistance. (13)
Additionally, herbs, unlike prescription antibiotics, may offer broad-spectrum antimicrobial properties, including antibacterial, antiviral, antifungal, and antiparasitic support (13). Natural supplements, including caprylic acid, oregano oil, garlic, and berberine, can therefore be considered to support the body's natural defenses and maintain balance in the microbiome.
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Summary
Antibiotics are medicinal agents that help manage bacterial infections. They are often, but not always, indicated in addressing bacterial illness. With antibiotic resistance on the rise and the growing concern about antibiotic side effects, exploring natural options for supporting health is of growing interest. If you are sick, talk to a healthcare provider about whether antibiotic treatment is needed. Functional medicine testing can help with medical decision-making to initiate correct and effective therapies. A holistic and preventive approach can also provide adjunctive, individualized support to address common antibiotic-induced microbiome disruptions and fungal imbalances.
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