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  2. The Janus face of Antibiotics: Life Savers & Microbiota Disrupters
  3. Ears, Nose and Throat microbiota: when antibiotics challenge our first line of defense

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

Drug
Otorhinolaryngology

By disrupting the microbiota in the ears, nose and throat (ENT), antibiotics may leave the door open to opportunistic pathogens implicated in ear and respiratory infections. Their effects could be particularly counterproductive in cases of acute otitis media.

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About this article

Created 25 August 2021
Updated 07 January 2022

What is commonly referred to as the “ears, nose and throat (ENT) microbiota” is in fact comprised not of one but rather of several microbiota. Antibiotics are likely to act individually on these different microbiota, ranging over the oral cavity through to the pharynx, including inside the sinuses and even the middle ear. This chapter is mainly devoted to the effects of antibiotics on the Upper Respiratory Tract (URT) microbiota, which is an excellent textbook case: the URT microbiota appears to be one of the safeguards of auricular health, yet it is threatened by antibiotics prescribed for this purpose, notably in cases of acute otitis media.

“Within 7 days of antibiotics being administered for URT infections, the incidence of acute otitis media has been shown to increase by a factor of 2.6.”

Pr. Teissier, MD, PhD

The URT microbiota, an ally of aricular health?

The URT microbiota is colonized directly after birth by a variety of commensals (Dolosigranulum Corynebacterium, Staphylococcus, Moraxella, Streptococcus). Mounting evidence suggests that a higher relative abundance of commensal species (Dolosigranulum spp. and Corynebacterium spp.) as well as a greater diversity in the nasopharyngeal microbiota1 are associated with a lower incidence of URT colonization by Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis,2,3 three otopathogens implicated in acute otitis media (AOM) .

 

Antibiotic treatment: much risk for little benefit

Exposure to antibiotics impacts the URT microbiota by decreasing the abundance of protective species and by increasing the abundance of Gram-negative bacteria (Burkholderia spp., Enterobacteriaceae, Comamonadaceae, Bradyrhizobiaceae),4,5 as well as S. pneumoniae, H. influenzae and M. catarrhalis.5 As a result of acquiring antimicrobial resistance, these bacteria, which could not otherwise successfully compete in this niche, are given the opportunity to multiply during treatment to an extent that they may become pathogenic.6 Furthermore, antibiotics are considered unlikely to confer any benefit in most cases of pediatric AOM (the primary reason for prescribing antibiotics to children7) and other URT infections (sore throats or common colds),7,8 due to the frequently non-bacterial nature of these conditions: from 60% to 90% of children with a AOM recover without antibiotics.9,10 Finally, antibiotics lead to gut microbiota dysbiosis that can translate into side effects such as antibiotic-associated diarrhea3,11 (see gut microbiota section).

Expert opinion

In flora hitherto unexposed to antibiotic treatment, there is a harmonious balance between the various commensal bacteria. Disrupting this balance with antibiotics can promote the proliferation of certain bacteria, likely to become pathogenic. In particular, the repeated intake of antibiotics promotes the selection of multidrugresistant bacteria that can no longer be kept in check by the commensal flora, which leads to the more frequent occurrence of infectious complications. It therefore seems essential to preserve the native flora and its natural balance by limiting the use of antibiotics to situations where they are strictly necessary.

Pr. Natacha TEISSIER, MD, PhD Pediatric ENT Department, Robert Debre Hospital, Paris (France)
Sources

1 Xu Q, Gill S, Xu L, et al. Comparative Analysis of Microbiome in Nasopharynx and Middle Ear in Young Children With Acute Otitis Media. Front Genet. 2019;10:1176.

2 Laufer AS, Metlay JP, Gent JF, et al. Microbial communities of the upper respiratory tract and otitis media in children. mBio. 2011;2(1):e00245-10.

3 Pettigrew MM, Laufer AS, Gent JF, et al. Upper respiratory tract microbial communities, acute otitis media pathogens, and antibiotic use in healthy and sick children. Appl Environ Microbiol. 2012;78(17):6262-6270.

4 Prevaes SM, de Winter-de Groot KM, Janssens HM, et al. Development of the Nasopharyngeal Microbiota in Infants with Cystic Fibrosis. Am J Respir Crit Care Med. 2016;193(5):504-15.

5 Teo SM, Mok D, Pham K, et al. The infant nasopharyngeal microbiome impacts severity of lower respiratory infection and risk of asthma development. Cell Host Microbe. 2015;17(5):704-715.

6 Rogers GB, Shaw D, Marsh RL, et al. Respiratory microbiota: addressing clinical questions, informing clinical practice. Thorax. 2015;70(1):74-81.

7 Mather MW, Drinnan M, Perry JD et al. A systematic review and meta-analysis of antimicrobial resistance in paediatric acute otitis media. Int J Pediatr Otorhinolaryngol. 2019;123:102-109.

8 Easton G, Saxena S. Antibiotic prescribing for upper respiratory tract infections in children: how can we improve? London J Prim Care (Abingdon). 2010;3(1):37-41.

9 Massa HM, Cripps AW, Lehmann D. Otitis media: viruses, bacteria, biofi lms and vaccines. Med J Aust. 2009;191(S9):S44-9.

10 Venekamp RP, Sanders SL, Glasziou PP, et al. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 2015;2015(6):CD000219.

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

Old sources

 

 

Tags
Otitis Atopic dermatitis Asthma Probiotics AAD C Difficile

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    See also

    Antibiotic exposure during first six years of life disrupts gut microbiota and impairs child growth
    Can statins combat intestinal dysbiosis?
    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 07 January 2022

    About this article

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    Main topic

    Drug

    Medical practice

    Otorhinolaryngology

    Content type

    Dossier detail
    Antibiotics, a double-edged sword when managing skin disease
    Antibiotic resistance: the lung microbiota pays a heavy price
    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?
    What's worth reading about microbiota
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    The Janus face of Antibiotics: Life Savers & Microbiota Disrupters
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