The objective with this report is to review and summarize recent studies concerning the adverse ecological effects of antibiotics on the commensal microflora of exposed individuals and the accompanying secondary diseases. The results are intended to be used by professionals in the health care sector in the context of antibiotic stewardship.
Det här är en systematisk genomgång av den vetenskapliga litteraturen om negativa ekologiska effekter av antibiotikaanvändning på individnivå. Den är tänkt som ett kunskapsunderlag att användas av lokala Stramagrupper, läkemedelskommittéer eller enskilda förskrivare i sammanhang när man diskuterar rationell antibiotikaanvändning.
Rapporten är skriven på engelska för att också kunna användas i de internationella projekt om rationell antibiotikaanvändning som Folkhälsomyndigheten deltar i.
To review and summarize recent studies concerning the adverse ecological effects of antibiotics on the commensal microflora of exposed individuals and the accompanying secondary diseases.
Materials and Methods
The PubMed database was systematically searched for studies published between 2009 and 2013 using the following three search phrases: "individual risk of antibiotic exposure", "collateral damage and antibiotics", and "adverse ecological effects of antimicrobial agents". Studies concerned with antibiotic side effects caused by collateral damage with direct effects on the individual exposed to antibiotics were included. Excluded were articles not addressing humans, those written in a language other than English, and those describing toxic and allergic side effects or pharmacological interactions. A total of 36 articles were included and were grouped into the following five groups: "Secondary infection", Inflammatory bowel disease/Irritable bowel syndrome", "Asthma, allergy, eczema, and rhinitis", "Obesity", and "Cancer".
Antibiotic therapy was found to be a risk factor for various subsequent secondary infections, i.e. infections with other bacteria than the initial infection. These infections include bloodstream infections, urinary tract infections, gastrointestinal infections, and – in the case of neonates – necrotizing enterocolitis. Antibiotic use in early childhood showed a weak association with asthma, although the aetiology of asthma is complex where several described environmental exposures interact with genetic inheritance to the risk for disease. No clear relationship was seen between antibiotic exposure and food allergies. The articles investigating the relationship between antibiotics and inflammatory bowel disease showed a different pattern for Crohn's disease and ulcerative colitis with a correlation only between antibiotics and Crohn's disease. It is unknown whether this reflects a shared susceptibility to infections and Crohn's disease or if antibiotic exposure is a factor in disease development or if the findings are due to bias. An association between prior antibiotic therapy and obesity and cancer was also studied in a few of the articles obtained from the literature search. However, these studies show conflicting or insignificant results, and a causal relationship is
The collateral damage associated with antibiotic exposure is a risk factor for subsequent secondary infections, and the antibiotic itself can have a negative impact on the individual patient due to its effect on the commensal microflora. Thus, in the treatment of bacterial infections, at least the less severe ones, the ecological side effects are important factors to keep in mind for the prescribing clinician .