Skip to main content
About the Institute
  • English
  • Français
  • Español
  • Russian
  • Portuguese
  • Polish
  • Turkish

Breadcrumb

  1. Home
  2. The Janus face of Antibiotics: Life Savers & Microbiota Disrupters
  3. From diarrhea to chronic diseases: the well-documented consequences of antibiotic-related gut microbiota dysbiosis
  • Our publications
    • News
    • Microbiota Mag
    • Thematic folders
    • Overviews - Microbiota Magazine
  • About the Institute
    • Partnerships
    • Press room
  • Congresses
    • Congress calendar
    • Congress reviews
  • Continuing Medical Education
    • Accrediting courses
    • Xpeer App
  • Useful documents
    • Infographic
    About the Institute

    Join the microbiota community

    • Facebook
    • Twitter
    • YouTube

Lay public section

Find here your dedicated section
Gastroenterology
Gynecology
Pediatrics
Dermatology

Breadcrumb

  1. Home
  2. The Janus face of Antibiotics: Life Savers & Microbiota Disrupters
  3. From diarrhea to chronic diseases: the well-documented consequences of antibiotic-related gut microbiota dysbiosis
Gastroenterology

From diarrhea to chronic diseases: the well-documented consequences of antibiotic-related gut microbiota dysbiosis

Drug
Gynecology Pediatrics Gastroenterology

Antibiotic treatment may sometimes take place without any obvious short-term side effects. Nevertheless, the dysbiosis triggers diarrhea for up to 35% of patients; in the long term, antibiotic-induced microbiota alterations may represent a risk factor for allergic, autoimmune or metabolic diseases.

Gastroenterology
Gynecology
Pediatrics
Dermatology
  • Our publications
    • News
    • Microbiota Mag
    • Thematic folders
    • Overviews - Microbiota Magazine
  • About the Institute
    • Partnerships
    • Press room
  • Congresses
    • Congress calendar
    • Congress reviews
  • Continuing Medical Education
    • Accrediting courses
    • Xpeer App
  • Useful documents
    • Infographic
    About the Institute

    Join the microbiota community

    • Facebook
    • Twitter
    • YouTube

Lay public section

Find here your dedicated section

Sources

This article is based on scientific information

Sharing is caring

Your colleagues might be interested in this topic. Why not share it?

  • Facebook
  • Twitter
  • Mail

Sections

Clostridium difficile spores surrounding a long Cl. difficile bacterium.

About this article

Created 25 August 2021
Updated 09 February 2022

Antibiotics are a powerful tool in the fight against bacterial infections. However, research has also documented detrimental effects on the trillions of commensal bacteria that live in the intestinal tract. This resultant dysbiosis renders the gut microbiota less able to fulfil its protective functions. In the short term, dysbiosis leaves the door open for opportunistic pathogens and the selection of multi-resistant bacteria. In the long term, the gut microbiota, despite having a certain degree of resilience, can sometimes fail to fully restore itself;1,2 this is understood to pave the wave to a range of diseases. Recent research has shown that antibiotics may alter the bacterial diversity and abundance of the normal microbiome and that this impact may be prolonged (typically 8-12 weeks after antibiotics have been discontinued).3,4

35%

Diarrhea occurs in up to 35% of patients who receive antibiotics3, 5, 6

Diarrhea, the most common adverse effect of antibiotics

As the main short-term consequence, some patients treated with antibiotics experience a change in their intestinal transit, most often resulting in diarrhea. The incidence of antibiotic-associated diarrhea (AAD) depends on several factors (age, setting, type of antibiotic, etc.) and may range between 5 and 35% of patients taking antibiotics.3,5,6

Expert opinion

Antibiotics disrupt the protective intestinal microbiota, which can lead to unintended consequences including antibiotic-associated diarrhea (in up to 35% of patients) and the development of antibiotic resistant strains of pathogens that are of global concern in regards to increased healthcare costs and mortality.

Lynne Mc Farland, PhD. Clinical Epidemiologist Public Health Reserve Corps University of Washington, Seattle

Among children this percentage can reach up to 80%.3 Most of the time, the diarrhea is purely functional, caused by the antibioticinduced dysbiosis. It is usually of mild intensity and is self-limiting, lasting 1-5 days. Antibiotics displaying a broader spectrum of antimicrobial activity like clindamycin, cephalosporins, and ampicillin/amoxicillin are associated with higher rates of diarrhea.6

The particular case of C. difficile 

In 10 to 20% of cases, diarrhea results from infection with Clostridioides difficile (formerly known as Clostridium difficile) colonizing the microbiota.6 This bacterium, which persists in the environment via spores, is a gram-positive, spore-forming, obligate anaerobe. Infection occurs via spores ingestion. Under specific circumstances (e.g., antibiotic-induced dysbiosis), the spores may germinate and vegetative bacterial cells of this opportunistic pathogen may colonize the intestines. In the infective phase, C. difficile produces 2 toxins that damage the colonocytes and trigger an inflammatory response with a variety of clinical outlooks, ranging from moderate diarrhea to pseudomembranous colitis, toxic megacolon and/or death.

 

FIGURE 2. Downstream effects of antibiotic-induced gut dysbiosis. (source : adapted from Queen et al., 202010)

Image

1/3

Nearly 1/3 of AAD cases are due to C. difficile3

Most recognized common risk factors for C. difficile infection (CDI) include age > 65 years, use of proton pump inhibitors, comorbidities and of course antibiotic use. The latest is the most relevant modifiable risk factor for CDI. The association of antibiotics with CDI has been established in hospitals and more recently in community settings,7 where the risk of infection varies from intermediate for people exposed to penicillins, high for these exposed to fluoroquinolones and highest for those receiving clindamycin. As for tetracyclines, they trigger no increased risk.8 In a hospital setting, the highest risk of developing CDI was observed for cephalosporins (from 2nd to 4th generations), clindamycin, carbapenems, trimethoprim sulfonamide, fluoroquinolones and penicillin combinations.9

When the gut microbiota becomes a reservoir of antibiotic resistance 

When exposed to antibiotics, microbial communities respond in the short term not only by changing their composition, but also by evolving, optimizing and disseminating antibiotic resistant genes. The human gut microbiota overly exposed to antibiotics is now considered a significant reservoir of resistance genes, in adults as well as in children.2 By contributing to the growing difficulty to combat bacterial infections, antibiotic resistance has become a major public health concern.

An open door to non-communicable diseases

Disruption of the gut microbiota resulting from antibiotic exposure is also suspected of increasing the risk of several chronic diseases by elevating inflammatory responses locally and systemically, thereby leading to a deregulated metabolism and compromised immune homeostasis10 (Figure 2, page 4). The perinatal period, characterized by the development of the immune system along with the maturation of the gut microbiota, has been shown to be a particularly sensitive time, one during which antibiotic-driven dysbiosis translates into long-lasting health effects, i.e. a higher risk of diseases later in life, including inflammatory bowel diseases (e.g., Crohn’s disease), atopic diseases (e.g., asthma) and metabolic disorders (e.g., type 2 diabetes, obesity).

Clinical case

by Lynne V. McFarland, PhD

  • 53-year old woman consulted her physician with a 3-day history of respiratory tract symptoms (cough, sore throat and runny nose) with fever and fatigue. No co-morbidities and was otherwise healthy. Her physician prescribed a sputum sample and a 10-day course of oral cefaclor (500 mg, b.i.d). The sputum cultures came back negative for pathogens.

  • She was admitted at hospital on the 3rd day of the antibiotics because she developed acute diarrhea (with six watery stools per day and abdominal cramping) and unresolved respiratory symptoms. Laboratory cultures (sputum and stool) were negative for pathogens. She was asked to discontinue her antibiotics, but the diarrhea continued for the next two days.

  • Her physician prescribed erythromycin (500 mg, t.i.d.) and a probiotic for one week. Her respiratory symptoms and diarrhea resolved within four days and she was discharged one day later with no complications.

Sources

1 Dethlefsen L, Relman DA. Incomplete recovery and individualized responses of the human distal gut microbiota to repeated antibiotic perturbation. Proc Natl Acad Sci U S A. 2011;108 Suppl 1(Suppl 1):4554-4561.

2 Francino MP. Antibiotics and the Human Gut Microbiome: Dysbioses and Accumulation of Resistances. Front Microbiol. 2016;6:1543.

3 McFarland LV, Ozen M, Dinleyici EC et al. Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections. World J Gastroenterol. 2016;22(11):3078-3104.

4 Kabbani TA, Pallav K, Dowd SE et al. Prospective randomized controlled study on the effects of Saccharomyces boulardii CNCM I-745 and amoxicillin-clavulanate or the combination on the gut microbiota of healthy volunteers. Gut Microbes. 2017;8(1):17-32.

5 Bartlett JG. Clinical practice. Antibiotic-associated diarrhea. N Engl J Med 2002;346:334-9.

6 Theriot CM, Young VB. Interactions Between the Gastrointestinal Microbiome and Clostridium difficile. Annu Rev Microbiol. 2015;69:445-461.

7 Kuntz JL, Chrischilles EA, Pendergast JF et al. Incidence of and risk factors for community-associated Clostridium difficile infection: a nested casecontrol study. BMC Infect Dis. 2011;11:194.

8 Brown KA, Khanafer N, Daneman N et al. Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection. Antimicrob Agents Chemother. 2013;57(5):2326-2332.

9 Slimings C, Riley TV. Antibiotics and hospital-acquired Clostridium difficile infection: update of systematic review and meta-analysis. J Antimicrob Chemother. 2014;69(4):881-891.

10 Queen J, Zhang J, Sears CL. Oral antibiotic use and chronic disease: long-term health impact beyond antimicrobial resistance and Clostridioides difficile. Gut Microbes. 2020;11(4):1092-1103.

 

Old sources

 

 

Tags
Otitis Atopic dermatitis Asthma Probiotics AAD C Difficile

en_view en_sources

    See also

    Actu PRO : Antibiotiques et microbiote intestinal : quels impacts sur le long terme ? What are the long-term effects of antibiotics on the gut microbiota?
    Actu PRO : La transplantation fécale, solution à l’antibiorésistance chez les patients immunodéprimés ? Is fecal transplant a solution to prevent antibiotic resistance in immunocompromised patients?
    Focus
    The Janus face of Antibiotics: Life Savers & Microbiota Disrupters
    • Introduction
      • The Janus face of Antibiotics: Life Savers & Microbiota Disrupters
    • Gut
      • From diarrhea to chronic diseases: the well-documented consequences of antibiotic-related gut microbiota dysbiosis
    • Urogenital
      • Urogenital microbiota: the spectrum of mycosis or urinary tract infections after each antibiotic treatment
    • Cutaneous
      • Antibiotics, a double-edged sword when managing skin disease
    • ENT
      • Ears, Nose and Throat microbiota: when antibiotics challenge our first line of defense
    • Lung
      • Antibiotic resistance: the lung microbiota pays a heavy price
    • Conclusion
      • What to take away?
    Created 25 August 2021
    Updated 09 February 2022

    About this article

    To know more about this topic.

    Main topic

    Drug

    Medical practice

    Gynecology Pediatrics Gastroenterology

    Content type

    Dossier detail
    The Janus face of Antibiotics: Life Savers & Microbiota Disrupters
    Urogenital microbiota: the spectrum of mycosis or urinary tract infections after each antibiotic treatment
    Focus

    The Janus face of Antibiotics: Life Savers & Microbiota Disrupters

    Introduction

    The Janus face of Antibiotics: Life Savers & Microbiota Disrupters

    Gut

    From diarrhea to chronic diseases: the well-documented consequences of antibiotic-related gut microbiota dysbiosis

    Urogenital

    Urogenital microbiota: the spectrum of mycosis or urinary tract infections after each antibiotic treatment

    Cutaneous

    Antibiotics, a double-edged sword when managing skin disease

    ENT

    Ears, Nose and Throat microbiota: when antibiotics challenge our first line of defense

    Lung

    Antibiotic resistance: the lung microbiota pays a heavy price

    Conclusion

    What to take away?

    Continue reading

    News
    Photo: Postménopause : l'action bénéfique de l'estradiol sur le microbiote vaginal
    22.06.2022

    Postmenopause: the beneficial action of estradiol on the vaginal microbiota

    Read the article
    22.11.2021

    Irritable bowel syndrome: is fecal microbiota transplantation effective in the long term?

    Read the article
    WMD_Foundation KOL Mexico 2019
    10.06.2022

    Pr. Moisés Alvarez (Mexican winner 2019): Microbiota & colorectal cancer

    Read the article
    WMD_Foundation KOL USA 2017
    17.06.2022

    Dr. Singh (USA winner 2017): Microbiota & polyphenols

    Read the article
    WMD_Foundation KOL USA 2021
    16.06.2022

    Dr. Queen (USA winner 2020): Microbiota & colorectal cancer

    Read the article
    WMD_Foundation KOL USA 2022
    16.06.2022

    Dr. Brown (USA winner 2021): Microbiota & respiratory syncitial virus infection

    Read the article
    31.05.2022

    Pr. Maslennikov (Russian winner 2019): Probiotics & cirrhosis

    Read the article
    WMD_Foundation KOL Russia 2020
    15.06.2022

    Pr. Shifrin (Russian winner 2020): Gut microbiota & antibiotics

    Read the article
    What's worth reading about microbiota
    Follow us on Twitter
    Read our thematic folder
    The Janus face of Antibiotics: Life Savers & Microbiota Disrupters
    NL13_cover
    Check out latest newsletter
    IBS, Microbiota & Covid-19
    • Our publications
      • News
      • Microbiota Mag
      • Thematic folders
      • Overviews - Microbiota Magazine
    • About the Institute
      • Partnerships
      • Press room
    • Congresses
      • Congress calendar
      • Congress reviews
    • Continuing Medical Education
      • Accrediting courses
      • Xpeer App
    • Useful documents
      • Infographic
      About the Institute

      Join the microbiota community

      • Facebook
      • Twitter
      • YouTube

    Lay public section

    Find here your dedicated section
    Gastroenterology
    Gynecology
    Pediatrics
    Dermatology
    • English
    • Français
    • Español
    • Russian
    • Portuguese
    • Polish
    • Turkish

    Browse the site

    • Our publications
      • News
      • Microbiota Mag
      • Thematic folders
      • Overviews - Microbiota Magazine
    • About the Institute
      • Partnerships
      • Press room
    • Congresses
      • Congress calendar
      • Congress reviews
    • Continuing Medical Education
      • Accrediting courses
      • Xpeer App
    • Useful documents
      • Infographic
      About the Institute

      Join the microbiota community

      • Facebook
      • Twitter
      • YouTube

    Lay public section

    Find here your dedicated section

    Discover

    Gastroenterology
    Gynecology
    Pediatrics
    Dermatology

    Join the microbiota community

    • Facebook
    • Twitter
    • YouTube

    Lay public section

    Find here your dedicated section

    Redirection

    You are about to be redirected and leave our website

    • Be redirected
    • Stay on the Biocodex Microbiota Institute's website

    Stay with us !

    Join the Microbiota Community of HCPs and researchers and receive once a month the “Microbiota Digest” to stay up to date on the latest news about microbiota.

    * Mandatory Fields

    BMI 20-35

    Explore

    Photo: Postménopause : l'action bénéfique de l'estradiol sur le microbiote vaginal
    22.06.2022

    Postmenopause: the beneficial action of estradiol on the vaginal microbiota

    Read the article
    WMD_Foundation KOL USA 2018
    17.06.2022

    Dr. Yang (USA winner 2018): Gut microbiota & gut brain axis

    Read the article
    WMD_Foundation KOL USA 2017
    17.06.2022

    Dr. Singh (USA winner 2017): Microbiota & polyphenols

    Read the article

    Stay updated

    Join the Microbiota Community of HCPs and researchers and receive once a month the “Microbiota Digest” to stay up to date on the latest news about microbiota.

    * Mandatory Fields

    BMI 20-35

    • Our publications
      • News
      • Microbiota Mag
      • Thematic folders
      • Overviews - Microbiota Magazine
    • About the Institute
      • Partnerships
      • Press room
    • Congresses
      • Congress calendar
      • Congress reviews
    • Continuing Medical Education
      • Accrediting courses
      • Xpeer App
    • Useful documents
      • Infographic
      About the Institute

      Join the microbiota community

      • Facebook
      • Twitter
      • YouTube

    Lay public section

    Find here your dedicated section

    Discover

    Gastroenterology
    Gynecology
    Pediatrics
    Dermatology

    Lay public section

    Find here your dedicated section

    Join the microbiota community

    • Facebook
    • Twitter
    • YouTube

    © 2022 Biocodex. All rights reserved.

    • Cookies Policy
    • Data protection policy
    • GTU
    • Sitemap
    • Cookies settings
    Biocodex logo