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BLOG: January 2010

 Antibiotic children

That sounds odd, doesn't it: antibiotic children? Even more so if you think of the inherent meaning of "antibiotic", which is pretty much the same as "anti-life". How could possibly children be anti-life? Of course, they're not; but, these days, it literally becomes a part of their lives.  Being generation born to antibiotics, they are bound to have some of their main attribute rubbed off onto them, one way or another.

Sure, antibiotics are great for emergencies, and can be life savers. But too much of anything spells trouble, and antibiotics are no exception. Not only that their side effects - the two major ones being immune system suppression and destruction of friendly intestinal flora - are becoming more of a liability the less their use is really needed.

Antibiotics also foster new generation of superbugs, evolving as a direct consequence of their overuse. The kind of bugs that increasing number of people will need all of their immune strength for, because there will be nothing else to turn to.

So, in a very direct way, by making children - and grownups alike - less naturally resistant to growing health treats, they do make them less viable as bio-entities or, if you will, more antibiotic.

Just published small Dutch study has found that the rate of recurrent acute otitis media (ear infection) in 6m to 2y olds is

nearly 50% higher in those treated by amoxicillin

(antibiotic of choice for treatment of ear infection) than in the placebo group (63% vs. 43%, respectively), in a 3-year follow up period (Bezakova et al, Recurrence up to 3.5 years after antibiotic treatment of acute otitis media in very young Dutch children: survey of trial participants, 2010).

The commentary calls this finding "surprising", stating that it is the only report so far showing such adverse late effect of amoxicillin in otitis media. It also states that study results call for further investigations on the late effects of antibiotic treatments.

The latter implies that no such investigations were conducted so far, which is nothing short of amazing - should we say reckless, too - considering how widespread is their use in general, and for ear infections in particular (which are the most common diagnosis in children, accounting for over 50% of all visits to pediatricians).

However, the notion that it is the only report so far indicating higher rates of recurrent ear infection associated with antibiotics use is uninformed. Lower recurrence of ear infection in children not using antibiotics has been noted in studies over two decades ago7. In fact, more than a decade ago, an analysis by a group of experts from U.S., U.K. and Netherlands concluded that antibiotics shouldn't be recommended as a routine treatment for ear infections, because:

benefit of their routine use is unproven; despite a number of studies, there is no compelling evidence that it results in shorter duration of symptoms, fewer recurrences, or better long-term outcomes

over 80% of children not treated with antibiotics recover, and evidence of benefit of antibiotics with the reminder of children is lacking

there is no sufficient evidence that use of antibiotics prevents complications from mastoiditis or meningitis, which is the main justification for their use

But the analysis does note that there is evidence of antibiotic use resulting in significant increases in resistant bacterial strains associated with ear infection, "including instances that have led to deaths from meningitis in children treated previously for uncomplicated acute otitis media" (Froom et al, Antimicrobials for acute otitis media? A review from the international primary care network, 1997).

The same report cites data showing that widespread antibiotics use is followed by rapid increase of bacterial resistance. For instance, in as little as five years (1990-95), resistance by one of the most common bacterial strains causing ear infections, Streptococcus pneumoniae, in England and Wales, increased from 1.5% to 3.9% for penicillin (same class of antibiotic as amoxicillin), and from 2.8% to 8.6% to erythromycin.

In the Netherlands, where antibiotics are not a part of the standard treatment for ear infection, the rates of bacterial resistance are 2 to 3 times lower.

Can this worrisome trend be stopped, or even reversed? Likely so. Another country that pulled back from antibiotics overuse, Iceland, had penicillin-resistant pneumococci soar to near 20% in five years, from 1988, when they appeared, to 1993. After campaign for reduced use of antibiotics - particularly for otitis media - and better control of infections in day care centers, the proportion of resistant pneumococci declined to 16.9% the very next year, and to 15% in 1995.

So - we have to ask that naive question - if all that is true, why was this 1997 report and overwhelming evidence of the inappropriateness of antibiotic use - or rather gross overuse - in treating ear infections ignored?

Does it have something to do with the majority of those writing practical guidelines for U.S. physicians being "financially tied" to pharmaceutical industry (Choudhry et al, 2002)? It is not that "bad doctors" use meningitis to scare parents into having their child take antibiotics for ear infections;

they are instructed to use that practice.

Does it have something to do with the fact that the other major source of information for the practitioners, medical trials published in prestigious journals like The Lancet, the New England Journal of Medicine, and the Journal of the American Medical Association, are funded by the industry to the tune of 3 in 4 (The Influence of the Pharmaceutical Industry, The House of Commons Health Committee, 2005)?

That industry funded clinical research is, on average,

5.3 times more likely to result in favorable conclusion

than non-commercially funded studies (Als-Nielsen et al, Association of funding and conclusions in random randomized drug trials: a reflection of treatment effect or adverse events?, 2003)?

That drug companies usually retain control over data from studies they sponsor, so that researchers themselves often have only a limited access to the results of their own studies (Bodenheimer, 2000, Schulman et al, 2002, from Abramson and Starfield, The Effect of Conflict of Interest on Biomedical Research and Clinical Practice Guidelines: Can We Trust the Evidence in Evidence-Based Medicine?, 2005)?

Never mind that earlier clinical studies showed that in nearly all children with ear infections - and particularly those with recurrent and chronic infections - symptoms are directly related to food and inhalant allergies, or compromised immunity, and that addressing them

resolves infections more effectively than surgical approach

(ear tubes, removal of the tonsils and adenoids). More so if other risk factors, such as bottle feeding and day care use, are also addressed.7

Something is rotten in the state of Denmark...

It is pharmaceutical industry that not only has a major role in formulation of clinical practice guidelines and contents of medical college education, but but also creates and controls most of medicine-related information for medical practitioners and the rest of us. Can we expect a business to sacrifice its interest for the common good? Not in the real world, and there is plenty of evidence to support that conclusion.

Why is this important? Because acute ear infections affects two in three of American children by the time they are 2, and chronic ear infections affect

two in three children by the time they are 6.

Because conventional medicine is throwing at the American children
2-3 million myringotomies (ear tube insertion, routine procedure after ear fluid persists after 3 months of routinely antibiotic treatment, which routinely happens in about 10% of children with ear infections), hundreds of thousands tonsillectomies, and tons of antibiotics, with or without these procedures, each and every year.

Lots of money in it - literally a multi-billion dollar business. Lots of adverse health effects as well, not seldom serious and/or lasting, from nausea and vomiting to anesthesia risks, from damage to ear structure to loss of hearing, and from mental retardation to potentially life-threatening complications, such as major vascular injury caused by myringotomy.

Add to it immune suppression, chronic candidias (intestinal dysbiosis) - often causing leaky gut - as well as fostering resistant bacterial strains by improper use and overuse of antibiotics, and you'll see clearly where do we stand right now: antibiotic people, raising the generation of increasingly antibiotic children...