Updated on December 22, 2022
- Antibiotics can have profound therapeutic benefits for patients, but they can also cause significant disturbances of the gut microbiome.
- In some patients, the damage caused by antibiotics can lead to colitis, which is best treated by repopulating the microbiome.
- A number of therapies are available to support healing of the gut microbiome, including probiotics, prebiotics, and fecal transplants, but more advanced therapies are being developed as the importance of gut health becomes increasingly evident.
The use of antibiotics is all too common in modern medicine, with risks that are becoming increasingly evident. Although they are life-saving in many instances, no drug is without potential side effects.
One of the more frequent and dangerous consequences of these medicines is antibiotic-induced colitis. Affecting roughly 500,000 patients per year in the United States, antibiotic-induced colitis is a risk factor for anyone who has taken the medication. Symptoms of gastrointestinal diseases and disorders have been reported in young and old patients after antibiotic use, with this risk increasing over time with each new exposure.
Throughout much of medicine’s history, and certainly in the case of antibiotics, bacteria have been presented as the cause of disorders and something to be eliminated. Although it is true that some bacteria do cause infection and disease, scientists are finding compelling new evidence that many of these microorganisms are not only beneficial but, in fact, vital for health as well. The use of antibiotics, then, must be reevaluated in light of these discoveries about the gut microbiome and its relationship to antibiotic-induced colitis. In doing so, therapeutic possibilities to support the health of the microbiome must expand.
The Gut Microbiome: An Ecosystem Living Within
A vast collection of bacteria, viruses, and fungi inhabit the human gut, creating complex ecosystems, known as microbiomes, that promote health and wellness. Not only do they aid in digestion, they also guard against colonization by harmful bacteria. Only in the last few decades have researchers begun to understand the complexity of the bacterial ecosystems found in the intestinal tract—and the intrinsic nature of how a balanced gut microbiome impacts an individual’s health.
New evidence suggests that a spectrum of disorders, from obesity to mental illness, might be influenced by the bacteria found in the gut. Given the complexity of the microbiome, and its mutualistic association with human health, it shouldn’t be surprising that antibiotic medication can have a deleterious effect. The primary reason is that antibiotics not only affect harmful bacteria but significant populations of beneficial gut flora as well, thus disrupting the gastrointestinal ecosystems. This can allow harmful bacteria to colonize within the gut, and when this occurs, these harmful bacteria can cause an array of illnesses, from diarrhea to antibiotic-induced colitis and even cancer.
Paradoxically, the standard treatment for antibiotic-induced colitis is to administer yet more antibiotics, with dismally predictable rates of recurrence. However, as research reveals further evidence of the importance of the gut microbiome, particularly its ability to prevent intestinal colonization of pathogenic bacteria, many medical professionals are considering complementary or alternative therapies focused on augmenting the gut microbiome. Recent data suggests the rapid repopulation of healthy gut flora can yield more successful results for combating antibiotic-induced colitis than traditional pharmaceuticals.
Antibiotic-Induced Colitis: Why the Gut Microbiome Must Be the First Line of Defense
One of the most basic components of one’s health and wellbeing is a healthy diet; the gut microbiome will interact with, and be affected by, everything eaten. Fresh fruits and vegetables, legumes, and complex carbohydrates help beneficial bacteria in the gut thrive. Additionally, fermented foods such as yogurt, kafir, and doogh have been used for centuries to support health, acting as probiotics to deliver beneficial bacteria to the digestive system, bolstering the gut’s microbiome.
Occasionally, however, when a patient’s gut microbiome is dramatically imbalanced, a healthy diet just isn’t enough. Sufferers of antibiotic-induced colitis who experience severe damage to their gut flora require a more direct approach for restoring its vitality. This is where probiotic supplements can provide nutritional support by delivering living bacteria directly to the gut and repopulating the microbiome with beneficial organisms. Although probiotics have come into common use, prebiotics are much less discussed and utilized.
Unlike probiotics, prebiotics don’t contain bacteria that repopulate the microbiome; instead, they provide vital nutrients to existing populations of beneficial bacteria in the gut, bolstering their proliferation. Nutritional supplements such as pectin and inulin consist of naturally occurring compounds found in foods high in indigestible fiber. Although indigestible to humans, certain species of gut microorganisms, such as bifidobacteria, thrive on these substances.
Furthermore, as the bacteria metabolize prebiotic compounds, the byproducts of this metabolism become bioactive. Some of this bioavailability allows these substances to be absorbed by the human host, providing increased nutrients. Other byproducts of metabolism are bioactive in other ways, such as having antimicrobial qualities against invasive and pathogenic bacteria. Often, prebiotics and probiotics are given together, with the two acting synergistically to rebalance the gut microbiome, offering an effective and natural solution for sufferers of antibiotic-induced colitis.
Microbiome and Fecal Transplants to Alleviate Antibiotic-Induced Colitis
In extreme cases of antibiotic-induced colitis, a procedure known as a fecal transplant has been shown to quickly repopulate the recipient’s gut with helpful bacteria, successfully restoring the microbiome. As the name implies, the procedure involves taking fecal matter from a carefully screened donor, processing it to a more refined material, and transplanting it into the gut of a patient. The goal of the treatment is to transfer the microbes from a healthy gut to an inflamed and damaged one, using the healthy microbes as the seed from which the gut’s microbiome can be repopulated.
In one study, five hospitalized and immuno-compromised patients suffering severe intestinal symptoms following antibiotic use, were given fecal transplants. The patients saw a resolution of their symptoms in several days and remained symptom-free for years after the treatment. Although antibiotics are currently the first line treatment for antibiotic-induced colitis, the successes seen with fecal transplants have many in the medical community advocating for the procedure to be more widely implemented.
Advanced Treatments for Antibiotic-Induced Colitis Must Go Beyond Antibiotics
Antibiotics are a common tool in modern medicine, with no indication this will change anytime soon. Thus, antibiotic-induced colitis can be expected to remain a challenge that doctors and hospitals will continue to face. Add to this the increasing resistance to antibiotics in some antibiotic-induced colitis patients, and the need for alternative methods to prevent and treat the disease becomes evident.
Studies demonstrate that repopulating the gut microbiome, whether through dietary modification, prebiotic supplements, or a fecal transplant, is a valid approach to combat antibiotic-induced colitis. Given how active an area of research this has become and the positive results of these studies, it’s likely that additional microbiota-based therapies will continue to be developed.
Although the ability of the gut microbiome to resolve conditions as serious as antibiotic-induced colitis appears to be close to miraculous, in reality, it is quite natural. Given the expense and risk accompanying the overuse of antibiotics, some medical professionals are beginning to consider alternative and complementary approaches to gastrointestinal diseases and disorders that support the microbiome, as opposed to devastating it. With current research demonstrating how important the flora of the gut is, this will continue to be a topic of interest for the medical community. This expanded understanding of the gut microbiome is certain to guide future therapies for antibiotic-induced colitis and increase the options for enhancing microbiome health.
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