Early antibiotic use 'may predispose children to weight gain and asthma' | Hacker News Reader

Early antibiotic use 'may predispose children to weight gain and asthma'

theguardian.com

88 pointsjunto61 comments

I wish it were easier to avoid their use, but without antibiotics my kids would spend like half the year with ear infections, miserable (and making everyone else miserable) and lethargic at best. Then there's strep—last year I discovered the hard way how dangerous that can be if you don't treat that very soon after symptoms start (I'd never had it, didn't realize what was happening/how serious it was at first)

I had strep every year around the holidays as a kid. It's a common, and easily treatable infection, but extremely dangerous left alone. It can go from bad to really bad, quickly, especially when it travels to the heart.

Yeah, so I learned. Didn't even have any of the more serious complications, but had nausea with it which led to dehydration and sleep deprivation. 72+ hours of that and I was in really rough shape, I'd guess not more than 12 hours from requiring hospitalization when I finally went to the doctor and got some drugs. Will not make that mistake again.

I believe that streptococcus bacterial infections can cause long term damage to the tonsils. It causes puts and holes, and people who have this often suffer from tonsil stones. You'll know if you've have them because every so often you'll cough one up and it causes halitosis.

Anyway, within the folds of the tonsils, streptococcus and other bacteria can survive, waiting for your immune system to become depressed, where it powers up again, making you ill.

Hence, you may think you have got rid of the infection, but it is just in stasis inside you.

This is one of the primary reasons that physicians recommend that you have your tonsils removed once you appear to have overly frequent repeats of strep throat.

Sadly, the removal of the tonsils often means that infections tend to end up further down the throat after having the tonsils removed, which being nearer to the lungs raises the risk of more serious illnesses later.

The danger to the heart is believed to be from the immune response to the strep, not the infection directly.

http://www.mayoclinic.org/diseases-conditions/rheumatic-feve...

Symptoms are the bodies response to infection. Regardless of what happens, because strep is present, then it occurs.

The point of my comment was that the infection does not travel to the heart. The immune response to the infection in the throat ends up having consequences elsewhere.

My son has to take antibiotics continuously because of an autoimmune reactions to strep (called PANDAS).

https://www.nimh.nih.gov/health/publications/pandas/index.sh...

Symptoms from the above link:

Presence of obsessive-compulsive disorder and/or a tic disorder Pediatric onset of symptoms (age 3 years to puberty) Episodic course of symptom severity (see information below) Association with group A Beta-hemolytic streptococcal infection (a positive throat culture for strep or history of scarlet fever) Association with neurological abnormalities (physical hyperactivity, or unusual, jerky movements that are not in the child’s control) Very abrupt onset or worsening of symptoms

The following anecdote may not really be applicable to children, but you might find it interesting anyway. I went through a period of getting an ear infection, being prescribed antibiotics, having it clear up, but then having it recur sometime later. After quite a few goes round this loop I decided to just take painkillers (ibuprofen was very effective for me) and wait it out, and the infections stopped coming back.

Ibuprofen is a NSAID where 'AI' stands for anti-inflamatory. Reducing the inflamation probably helped draining your ear through the Eustachian tube.

Ear infections aren't always bacterial. They can be fungal. Antibiotics will do zero if it's fungal. Do NOT go to a general practitioner with an ear infection. They will prescribe antibiotics and tell you to get lost. Bad idea. Go to an ENT (ear-nose-throat doctor) instead. They have the right equipment on hand and the experience necessary to properly identify what you have and how to treat it. They will take away the pain in minutes by relieving pressure using specialized equipment. Huge mistake to go to a regular doctor.

Or go to the pharmacist. There's a few products that you can drip in your ear for ear infections and you'll save a doctor visit.

Pediatric doc here. True, many are not bacterial but fungal ear infections are quite rare. The majority of otitis media is viral, which is not surprising given the concurrent URI that most kids (and adults) have when they get a painful ear. This is also the reason I try to have parents wait out ear infections in their kids ... I'd rather not use antibiotics, especially when they have a viral infection that wouldn't respond anyway. I'm not sure what tools you're referring to in the ENT office. If the ear infection is external (i.e. Swimmer's Ear) any GP office should be able to culture and treat it. If it's a middle ear infection (and that's usually what we're talking about), an ENT still has to deal with the fact that the tympanic membrane blocks access to the middle ear. Only in very extreme cases would an ENT consider violating the TM to sample the middle ear.

> I'm not sure what tools you're referring to in the ENT office.

I don't know the exact terminology, but it's essentially a vacuum with a thick needle point. They use it to suck out and clean the debris from inside the ear. All the pus and other liquid in there. You regain your hearing and the pain subsides. They can then put the medicine in after.

I've only had fungal infections, so I can't speak to viral or bacterial. For fungal, they essentially treat it with vinegar and steroids. The vinegar kills the fungus and the steroid is for inflammation. I had to pay $100 bucks at the pharmacy for the otic solution for what is essentially vinegar. Not a doctor, just what I was told.

I think that the challenge we have is that today's antibiotics are really like the proverbial "sledgehammer to crack a nut".

There hasn't been a great deal of interest in discovering new antibiotics, as this extract from Wikipedia describes:

  Following a 40-year hiatus in discovering new 
  classes of antibacterial compounds, four new 
  classes of antibacterial antibiotics have been 
  brought into clinical use in the late 2000s and early
  2010s

I assume that there isn't much interest due to the limited financial rewards to the pharmaceutical industry.

What is really needed is a new way to target the truly " foreign " and trouble making bacteria in the body, and eradicate it. Hopefully in the next 40 years we can make such a breakthrough and stop the "carpet bombing" methods we have today.

Most of the antibiotics you're going to get from your PCP are old chestnuts like amoxicillin (1972) and doxycycline (1967).

I wish it were easier to avoid their use

There are things you can do to reduce their need. A few things off the top of my head:

* Take shoes off at the front door (like Japan and a few other civilized places).

* Do not let the kids get on their beds wearing street clothes.

* Use hot baths and peroxide (in the ear) to help kill infection before it is so advanced that it requires antibiotics.

Of course, those things take work and are inconvenient, something many Americans seem allergic to. But if you really want to reduce antibiotic use, it absolutely can be done.

We already tick the other boxes, but may try the peroxide thing. I'd heard of it for cleaning ears, but not fighting infections. Thanks for the tip.

There is a lot more that you can do. Keep researching it. It gets easier the further you go.

I apologize if my original comment came across as snarky.

Best of luck.

I read once a blog post [1] that I am constantly reminded of. The author had a problem that he frequently gets ear infection, because he rides his car with windows open (unscrewed to be honest). After seeking professional help and failed antibiotics treatment he went with one idea. He was warming his ear with halogen lamp by setting the light so it would go inside his ear. It worked.

I never had such infection so couldn't check validity of this myself.

[1] In Polish: http://frycz.pl.salon24.pl/335341,zapalenie-ucha-wewnetrzneg... Google Translate: https://translate.google.com/translate?sl=pl&tl=en&js=y&prev...

terrible advice

too much hygiene weakens your immune system, exposure to common bacteria and fungi at a low level is good for it

and don't put anything in your ears! (except maybe salt-water), especially not peroxide which will cause irritation and maybe even scarring

Yep. Makes me wonder...

I'm overweight and asthmatic....and had frequent ear infections as a toddler.

I can relate! I had ear aches nearly every week or it seemed like it when I was a kid in the 70s it was really bad. I got to like the taste of the orange Aspirin tablets my mother would crush them into some sugar.

When my father stopped smoking all my ear aches disappeared.

Having lived in the US and moved to Austria, I can say it's quite comical how few times doctors prescribe antibiotics here. It's something like 10:1.

At times this is frustrating because you want the easy fix and when antibiotics work they work really well.

It's also quite illuminating how many symptoms do not seem to benefit from taking antibiotics even when they are the knee-jerk treatment.

I sometimes joke that modern medicine is 50% prescribing cortisone and antibiotics.

I've noticed that if I am very sick, even with antibiotics, I don't start getting better until 5+ days after first dose. Wondering what my body would naturally do with those five days, I've basically stopped going to the doc and just fight it off myself.

Really haven't noticed a difference. I'm talking stuff like ear pain, pink eye, severe sinus pain, ect. Don't know what I've had (since I didn't go to the doc, though I don't think they know half the time anyway..), but I survived it.

I'm sure there are valid reasons for antibiotics, but they are clearly over prescribed.

You're an outlier then. Within twenty-four hours of taking an antibiotic, I've always felt MUCH better. I will agree they are over prescribed, especially for things that don't even respond to antibiotics(viruses). But there is no denying their effectiveness.

How do you know he's the outlier?

Occam's razor. Antibiotics aren't over-prescribed/over-used just for giggles. It's because when they're actually necessary, they usually improve one's health quite quickly.

I've had an antibiotic shot a couple of times and that was amazing. Going from tonsils so swollen they were touching and impeding my breathing to being able to eat my first meal in days just a few hours later. Was quite amazing!

> especially for things that don't even respond to antibiotics(viruses). But there is no denying their effectiveness.

Wait. What?

Not everything responds to antibiotics.

Viruses are an example of not responding to antibiotics.

Doctors sometimes prescribe antibiotics for things they wont work for.

Antibiotics can be very effective against some diseases.

Sample group of me, my wife, and my son. We see symptoms die down in 24-48 hours. Its very clear they work, especially in my case where I've always had a long hard struggle fighting off infections.

I do make an effort to get more Vitamin D in the winter, which has been helping me avoid getting sick, but not recover faster.

>Wondering what my body would naturally do with those five days

Strep can become deadly in children. Invasive strep has a significant mortality rate, and that's with treatments. If you think you have strep you should get treated.

Also, I find it amusing you consider drugs unnatural. We are a tool using species, naturally. Developing and using drugs is in our nature.

Lastly, this is the same reasoning anti-vaxxers have, so I'd be careful here. It can lead to some really bad outcomes.

>Also, I find it amusing you consider drugs unnatural.

Strange, I never said anything like that. I'm simply sharing my story. Yes I am kind of a cheapskate, and I don't like blowing my money on something that I don't get results from. I'm in my 30's, been to the doc plenty of times. Never really felt like it was worth it. But my health is perfectly fine, maybe in 10 years that won't be the case and I'll be forced to like the doc no matter what.

Don't try this with any kind of infected bite (human or animal). You will lose limbs or die.

One should be able to judge the severity. I was bitten by a small dog once on the middle finger. It swelled up pretty big the next day, started draining puss from the teeth holes, was red and hot to the touch. Had to take some pain pills just to go to sleep that night. Was better in the morning though, so didn't go to ER.

You got lucky. Go the ER next time.

If you want to take your life into your own hands, the way to monitor the infection is by using a pen to draw a line around the red part. If the infection spreads outside the line, it's time for an infectious disease specialist.

Sinus infections are pretty hard to treat with antibiotics.

That was partly to blame to my protest. Either way (doctor or not) it is 10-14 days of pain and drowning in my own snot.

how do you know what you have is bacterial as opposed to viral? You may be taking antibiotics for no reason.

I don't, but how would the doctor know? I've gone in plenty of times with horrid conditions, hacking up all colors of the rainbow, and barely able to talk. Yet was told it was allergies... My brother-in-law a few months ago had horrid throat pain and swelling. The Doc said it was strep (I think they even did a test too). The antibiotics did nothing. Once his throat got to the diameter of a pencil a few days later, they rush him to the ER. They said it was mononucleosis.

The symptoms you're describing can all be part of viral processes. Antibiotics will do nothing for these conditions.

Whenever you read the word "may" in the title of an article about a scientific study, you should mentally fill in the end..."then again, it may not"

Unbelievable.

I wonder if there's a correlation between kids with asthma/weight gain and pre-labor antibiotics given to the mother to control Group B strep.

That seems like it could be the sort of study that could be done based on a medical records search, as the data should be recorded. (not that it's easy to get the data...)

Antibiotics were first discovered around WW2. Use of antibiotics was rampant in early years (it's come down since then, but is still excessive).

Why do we see a rise in obesity only in the last 20-30 years?

One of my pet theories is that is has to do with the decline in cigarette smoking.

It's funny, I've seen this before and my experience is the exact opposite. I've got 2 kids that were on what feels like a million antibiotics when they were young, one's thin, one's average. I've got a 3rd kid was NEVER on them at all, he's obese. I know this and other studies are population averages and all that, but it always surprises me when my experience is the exact opposite. Something to do with what gut microbes were killed or something?

Killing gut microbes considered harmful...

What?

I think a lot of people are suggesting these days that interfering with gut biome with things such as anti biotics can have far reaching effects on the rest of your system.

Maybe you don't agree with this but I think there is research suggesting, for example, having the wrong gut bacteria can make you more likely to be over weight, be a factor heart disease and even diseases like Alzheimer's are implicated.

Even depression. If you read about candida or yeast overgrowth, it is believed to cause some kind of inflammation which might be linked to depression.

Careful though. There is a lot of pseudoscience and quackery around candida and yeast.

It's an interesting hypothesis but unfortunately a cohort study with no randomized control and n=236 isn't really meaningful. There's no control at all here and the sample size is tiny.

236 is a massieve sample size and it is more than sufficient for showing an effect here. The p-values are below 0.001, and while p-values aren't everything, it's a strong indicator that the result is statistically significant.

Sure, the correlation is statistically significant. Without a control to infer causality the results become much less interesting.

To infer causality in an epidemiological study such as this you need very large cohorts with very specific results.

Even with huge cohorts you still have relatively indefensible results. The 7 country study is a good example: https://en.wikipedia.org/wiki/Seven_Countries_Study

Particularly since one of the connections they postulate is between antibiotics and asthma, I'm curious how they control for respiratory infections which seems like a much more likely common cause.

p-value is almost irrelevant if you don't know how many overall statistical tests were performed. Finding a p<0.001 "significant" result after testing 1,000 different variables is far less meaningful than finding one after testing 5 variables.

Interesting article and it is a coincidence in my life. My wife is pregnant and has been diagnosed with Group B strep and the dr has said she will be given Ampicillin during labor. I have some concerns regarding this, and now I read this article.

Dr says that there is 1 in 1000 chances of the baby getting (very) sick. With the antibiotics the chances are 1 in 4000.

I am wondering if anyone here has had experience with this.

Ped doc here. Group B strep can cause severe sepsis in neonates and I would definitely recommend that she get 1-2 doses of an antibiotic while in labor. I have not seen any good evidence that this sort of treatment causes any problems down the road for the baby. Furthermore, if you consider the mechanism that this paper suggests, it involves the manipulation of gut flora. A neonate's GI tract is sterile when it comes into the world, and is colonized over the first months to years of life. So since there are no bacteria to affect, this proposed mechanism should have no relevance. Also, Amp's half-life is just a few hours so no long-lasting presence in your baby. Don't mess with group B strep--before we understood how to deal with it, it made a lot of babies very sick and many died.

Good, that the usage of antibiotics is rising in cattle-breeding.

The blind usage of the fruits of progress is one of our biggest problems in a world, where many problems of human beings have relieved by the same.

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