Antibiotic and gut Microbiome

One of the side effect of antibiotic is the change of gut bacteria flora. Would the injection route of antibiotic cause less of the problem here than the oral route?

Particularly for a long term administration of antibiotic, is a depo injection dose better than a 20 day oral of twice a day?

One of the side effect of antibiotic is the change of gut bacteria flora. Would the injection route of antibiotic cause less of the problem here than the oral route?

Particularly for a long term administration of antibiotic, is a depo injection dose better than a 20 day oral of twice a day?

A primary reason for using parenteral (i.e., IV or IM, non-oral) antibiotics is to achieve higher sustained blood levels of the drug than you can produce by taking the same drug orally, usually to treat more severe or difficult infections. So you may need to be admitted to hospital for IV antibiotics if the doc thinks the infection either won't respond to oral drug, or sometimes after you've taken oral meds and they haven't worked.

I never used depot antibiotic injections in my medical practice so can't speak to when to use them, but my guess would be that serial IV antibiotic injections probably give you higher blood levels than depots would. But for gut flora specifically, the local gut concentration of oral meds could conceivably be higher than by other routes - drug delivery and metabolism can be very complex, so you would need to look up data on effect of various administration routes on gut flora of a particular antibiotic drug.

What is your interest in posting these questions? This is a "Medical but non-MedFet" labeled thread, which I trust means you're not interested in unnecessary antibiotic injections just for a MedFet application?

Eric

Thanks Eric for reply. I admit I do have an interest in injection play but this one is a medical need.

I had a tick bite discovered Sunday evening. It has grow bigger and red around the wound, size of a quarter. Flat not raised. Looks to me an EM rash plus cellulitis due to infection. I was just in doc office and prescribed 21 days of doxycycline. I worry about my gut bateria now.

I so wish it could be in form of injection, depot or daily. One to protect the Microbiome, two if i were to take an antibiotic anyways, would so much prefer to take it by IM.

Pmus,

Sounds like the right treatment so far. I never used anything but very short term IV antibiotics in my hospital practice, so don't know if any depot drugs are appropriate for this, but I'd doubt it, as they are much less common than oral or IV antibiotics. I cant speak intelligently about gut microbiome effects, but unless you're having major GI symptoms from the antibiotic, I wouldn't be too concerned. They should repopulate fine after the abx are completed. Whether any other route for your antibiotics other than oral/PO would have any difference in effect on your gut bacteria would take some research, starting with a clear statement of the research question. In other words, what exactly are you concerned about and what are you trying to accomplish with a different drug route (or different drug altogether)?

But a tick bite with cellulitis is nothing to fool around with - you are smart to have it treated. What did you mean by "EM rash"?

Eric

@pmus

You really do not have to worry about 21 days of doxycycline (usually 100mg bid) adversely affecting your gut. It will repopulate.

Doxycycline has been used for decades in oral surgery for grafting and regenerative procedures for extended periods (21+ days) without permanent changes to the gut flora. It has also been used as a post exposure medication of choice for Lyme Disease for the same extended (and much longer) periods.

If you want to ensure that you get a wide variety of flora during your antibiotic treatment and after, just lick your fingers after holding a shopping cart at the food store. That will give your gut some variety! 😁 OK, just kidding on that one. Eating probiotics, foods with live bacteria (cheeses, yogurt but NOT at the same time you take the doxycycline since tetracyclines can be chelated and partially deactivated by calcium, but less so with doxy than other tetracyclines) also oral sex and French kissing which is fun will help maintain diversity in the gut. I couldn't leave that one out because it does work and that (giving birth) and tasting the food you give to your baby is how they get their gut flora.

. . . . and that is my professional statement.

It seems that ignorance abounds and logical opinions may or may not be correct. Until much more research is done and verified there are only guesses about what gut flora are beneficial , benign or detrimental. Tread lightly and carefully when deciding what actions are bad or good. Perhaps in a few years, we will have actual data. Until then, distrust any opinions you hear. Well meaning people can be wrong too.

Pmus,

Why are you so concerned about your gut flora? Have you had problems in the past? What exactly do you think is the advantage of an IM antibiotic injection? Data?

Thanks,

Eric

Thank you all for replying.

@ericmacson EM I mean erythema migran. The rash associated with Lyme disease. The health of gut bacteria is actually a recent hot topic, as people started to realize the connection between microbiome and conditions like bowl inflammation, depression and other things such as obesity, all of which have previously never been linked to microbiome. So it’s new knowledge. I personally had a case of GI infection which lasted about a week and treated with antibiotic but my stomach never felt the same and I had loose stool ever since. I was thinking that logically an antibiotic that is taken by the mouth will kill off gut flora first before it works its way to the targeted area, but an injection can leave the gut less affected by the antibiotic.

@SwitchableSusie thanks for the advice. Not gonna lick the shopping cart though, no offense lol. Diversity is not the key, bad ones can be part of the diversity but not wanted. C. diff. for example. The unfortunate thing is that repopulating a good flora doesn’t seem to be always easy or successful spontaneously.

@trucker agree with what you say. Except some times decisions are hard to make. After I pound over the risks and benefit I did start taking the doxy pills. Oh my god did I vomit. I couldn’t keep the medicine down. I consistently puke everything I have in my stomach in less than half an hour after I take the pill. I almost feel I became sensitized to it. So I gave up during the weekend. I will call doc office first thing tomorrow morning see what they can do. I still think that a depot penicillin, like the Bicillin LA would work. I don’t understand why that wasn’t the first option. They offer this to syphilis exposure. Same type of bacteria: spirochete, and they both affect neural system eventually.

@SwitchableSusie thanks for the advice. Not gonna kick the shopping cart though, no offense lol. Diversity is not the key, bad ones can be part of the diversity but not wanted. C. diff. for example. The unfortunate thing is that repopulate a good flora doesn’t seem to be always easy or successful.

The microbial cleanout you get in a colonoscopy prep is far more complete than after a long course of antibiotics. Don't worry about it.

Over the last few years, I've had a lot of various antibiotics, both oral and IV. In general, the IV antibiotics caused me no problems, but the oral ones gave me the runs badly, despite also taking probiotics and Imodium.

Eventually, I wound up with C Diff as I've described elsewhere here. For a while I had a bowel catheter because I was pooing the bed so frequently. This was sort of relieved by oral Vanco, but even after a couple of weeks on the oral Vanco my pooing was nowhere near normal.

A nurse friend suggested unconventional therapy and I agreed. The therapy was plain, warm water enemas until clear (usually this took two enemas, of about 2500ml each, given in the Sims position and expelled on a bedside commode.

The cleansing enemas were followed by a probiotic enema of about 100ml (several probiotic capsules dissolved in chlorine free bottled water) given with a 150ml piston syringe and a Fr #30 colon tube, inserted fully, in the knee chest position. After the probiotic was injected, I stayed in the K-C position for a couple of minutes then changed to the Sims position and lay in bed for another half hour. This was done at bedtime for several nights and was quite successful.

More update: since I couldn’t keep the doxycycline down, I called doctor and the prescription was changed to amoxicillin by mouth. I hope this is easier on the stomach.

Amoxicillin is sensitive to gram positive. This will probably selectively breed my gut bacteria to a different type but the likelihood of C. Diff. taking over is less. I do still think that as the recent research on gut bacteria progress the use of oral antibiotic will be looked at as less safe as it is portrayed now and injection administration of antibiotic might make a come back in medicine practice. Just a guess and outlook. For now, I have got to try this oral amoxicillin.

Pmus,

Good luck with the amoxicillin. I hope it's easier on your stomach than the doxycycline.

Eric

Your intestinal flora is fine as long as you are taking it as prescribed. Personally, any antibiotic I take tears up my gut but the flora is fine!

Good luck with your Amoxicillin. If you are still worried about your flora try a probiotic.

Anibiotic injection courses are the best 😎

Come take yours, panties down ! >😃

Your intestines contain about 100 trillion bacterial cells and up to 2,000 different kinds of bacteria, many of which help protect your body from infection. When you take an antibiotic to treat an infection, these drugs tend to destroy some of the normal, helpful bacteria in addition to the bacteria causing the infection. Without enough healthy bacteria to keep it in check, C. difficile can quickly grow out of control. The antibiotics that most often lead to C. difficile infections include fluoroquinolones, cephalosporins, penicillins and clindamycin.

Once established, C. difficile can produce toxins that attack the lining of the intestine. The toxins destroy cells and produce patches (plaques) of inflammatory cells and decaying cellular debris inside the colon and cause watery diarrhoea.

Medication-associated risk factors include:

Currently taking or having recently taken antibiotics

Taking broad-spectrum antibiotics that target a wide range of bacteria

Using multiple antibiotics

Taking antibiotics for a long time

Taking medications to reduce stomach acid, including proton pump inhibitors

Treatment for recurrent disease may include:

Antibiotics. Antibiotic therapy for recurrence may involve one or more courses of a medication (typically vancomycin), a gradually tapered dose of medication or an antibiotic given once every few days, a method known as a pulsed regimen. The effectiveness of antibiotic therapy declines with each subsequent recurrence.

Probiotics. Probiotics are organisms, such as bacteria and yeast, which help restore a healthy balance to the intestinal tract. A yeast called Saccharomyces boulardii, in conjunction with antibiotics, might help prevent further recurrent C. difficile infections.

In addition we have found using natural Greek yoghurt with live bacteria can be helpful in preventing and treating C. difficile infections. and some ICU's/ITU's have started giving probiotics as routine when beginning any antibiotic therapy.

Hope this helps

Extremely well stated. I hope everyone reads this.

Thank you @RN1993 for the in-depth information.

You listed four types of antibiotics being more easily inducing c. Diff. Is there data in terms of rate of each of them? They seem to be very commonly used antibiotics. Tetracycline family is not mentioned, are they better?

I need to read up about other families, but penicillin is mainly eliminated by renal route and the liver metabolize it to an inactive form which then excreted in bile then out through lower GI tract. Tetracycline -particularly doxycycline- is mainly eliminated through bile unchanged. This makes me think that there will be higher concentration of doxycycline in the lower GI than there is penicillin? Logically, I’d expect the penicillin, or other drug mainly by renal route, to be safer in this aspect?

Agree probiotic is important. Any suggestion on how to take them? Greek yogurt. Notes taken. But during the course of antibiotic, isn’t all the good bacteria in yogurt killed by the antibiotic upon arrival? How do ICU do it?

Hello pmus

Check the following link , it should help answer some of your questions

https://www.healthline.com/nutrition/what-to-eat-antibiotics

Hopes it helps

RN

@RN1993

Your post about antibiotics was quite interesting.

I had a UTI some months ago and was on antibiotics for a few weeks. It actually took two rounds to completely cure the issue. But, ever since I have had issues with loose poo. I used to poo fairly firmly and about once every 24 to 36 hours; since the antibiotics it has been more like every 8 hours. Also, the urge comes on suddenly and is strong.

My suspicion is that the antibiotic killed of some variety of gut microcritters and they are no longer there to process poo and firm it up. I've tried a couple of brands of probiotics as well as a yogurt with "active cultures", both orally and as retention enemas, and it has helped some, but I still have to take Imodium twice a day to keep pooing under control. Were it not for the Imodium, I'd need diapers.

Do you know of any commercial probiotics that will fully restore the gut flora?

Do you know of any commercial probiotics that will fully restore the gut flora?

FERMENTED foods.

Sauerkraut, kimchi, yogurt with active cultures, cabbage

It will take 2-3 weeks to recolonize your colon.

Keep it up, don't stop eating fermented foods. It takes time, but the colon bacteria will repopulate.

Do you know of any commercial probiotics that will fully restore the gut flora?

When my sub was given a strong antibiotic for his pneumonia, 3 or 4 years ago, the doctor suggested a probiotic with two specific things in it. I am not remembering what they were but I read all the boxes until I found them. You could ask your doctor for their suggestion.

@Sean

If you have continued diarrhea, you MUST get a fecal culture to rule out Clostridium difficile.

Hi Sean

You may want to follow this link it provides useful information about restoring the intestinal flora of the gut .

https://www.quickanddirtytips.com/health-fitness/healthy-eating/foods-to-restore-your-intestinal-flora

@SwitchableSusie

If you have continued diarrhea, you MUST get a fecal culture to rule out Clostridium difficile.

I had C Diff some years ago and this is not C Diff. I don't have the runs but just a couple of poos per day. But this is more than I had before the antibiotics. Hence the query.

I still have to take Imodium twice a day to keep pooing under control. Were it not for the Imodium, I'd need diapers.

That description sounds loose to me. Check it out if it doesn't clear up.

The girl who started me on enemas had a problem with her flora being compromised and she also had IBS. She had a few problems like urine retention like when she sneezed or coughed she would squirt. But her flora problem was believed to be caused by very long-term use of antibiotics. We are not talking days but months. When she was growing up she lived in a small town and the doctor loved to prescribe antibiotics. Sore throat here have some antibiotics. Cut your knee here have some antibiotics. Have a cold it could be pneumonia or not a virus here have some antibiotics. She had this idea of adding my flora in her. She wanted me to take an enema, hold it, remove the hose from the bag and put it in her. That never happened. I was scared. At the time I had not even heard of this or if I did hear about it in school I didn't think much about it. I read up on it and for cases where it is needed there is a flora exchange treatment. But that is done in a medical setting where everything is tested. But a short stint of antibiotics you should have nothing to worry about. If you keep having problems see a doctor.

@Tabitha32

Yes, the procedure you suggest is called a Fecal Transplant and has been described in the medical literature, sometimes as a cure for C Diff.

The problem is that not only the beneficial microcritters can be transferred. Some really nasty diseases can be communicated this way.

For that reason alone, I'm not going there, thank you.

Feces used in the transplant is not a random sample. It is tested for pathogens and often comes from a family of household member because they are generally similar to the patient.

"Fecal transplants have a high success rate. The difficulty is getting the donor and receiver aligned and bent over at exactly the right height to complete the transfer."

Told to me by a real Doctor when I asked how effective it was. He was a real character and a good doc. 😀. They had a CDiff breakout on the floor. My wife had a lose BM transferring to the floor so they expected CDiff. Three days later they dropped the yellow gowns and claimed her ok.