Antibiotic Resistance and their Side Effects

Over-prescribed antibiotics are becoming less effective as bacteria build resistance. Anti-microbial resistance is a real concern, with predictions it will result in millions of deaths annually. Ever stronger antibiotics can cause debilitating side-effects and subsequent illnesses such as Thrush and Vasculitis.

Bacterial Resistance to Antibiotics

Most people, when they suffer their first few episodes of cystitis, seek a medical cure in the form of antibiotics. Initially, antibiotics can be very effective, especially if you have never had cystitis before. However, with every additional infection, that particular antibiotic is likely to become less effective, as the bacteria gradually build up resistance. We have reached the point in 2017 when no one could fail to be aware of the concerns regarding antibiotic resistance. Jim O'Neill, who chaired the review panel looking at Drug-Resistant Infections from 2014 - 2016, warned that by 2050 antimicrobial resistance could result in 10 million deaths a year. He suggests that doctors resist prescribing antibiotics until they have carried out tests to prove the infection is bacterial.

We must stop treating antibiotics like sweets, which is what we are doing around the world today.

Doctors are very aware of these concerns and are unlikely to want to keep prescribing more powerful antibiotics without extensive lab testing. Because if E.Coli develops resistance, standard antibiotics like Trimethoprim may no longer work. When that happens, episodes of cystitis could last longer and have the potential to develop in to kidney infections. Thorough investigation of serious Urinary Tract Infection involves testing cultures of the bacteria found in the urine. Tests are performed against a variety of antibiotics, both in isolation and combination, to find the most effective narrow spectrum antibiotic.

However, testing is costly. And worse for the patient, it takes time. When someone is clearly ill, broad spectrum antibiotics may be deemed necessary immediately. Common sense dictates that if doctors wait to get laboratory results before prescribing, an infection could develop rapidly, so it is hard for both patients and their doctors.

Sadly, we talk to people every day who have acquired resistant strains of bacteria that are no longer responding well to antibiotic therapy. ESBLs, Extended Spectrum Beta Lactamas, are an example of this.

ESBL-producing bacteria have joined the growing number of antibiotic resistant pathogens that cause hospital-acquired infections. ESBL bacteria are different from other superbugs, because ESBL does not refer to one specific kind of bacteria. For instance, MRSA refers specifically to methicillin-resistant strains of Staphylococcus Aureus whereas ESBL's are enzymes made by bacteria such as Klebsiella and E. coli, both common culprits in Urinary Tract Infections. This enzyme, beta lactamase, is an antibiotic-resistance enabling enzyme that the bacteria produce to protect themselves from attack.

Usually, ESBL's are harmless and live in the body without causing infection. But when ESBL's get into a part of the body where they do not belong, like the blood or bladder we may experience serious problems.

Reported side effects of broad-spectrum antibiotics, and in particular Fluoroquinolone based antibiotics such as Ciprofloxacin, may be rare but are varied.

Antibiotic side effects: Cardiac Risks

• Heart attack
• Heart murmur
• Heart palpitations
• Angina
• Cerebral thrombosis

Antibiotic side effects: Neurological risks

• Convulsive seizures
• Psychosis
• Depression
• Hallucinations
• Paranoia
• Insomnia
• Nightmares
• Dizziness

Antibiotic side effects: Gastrointestinal Risks

• Liver failure
• Jaundice
• Gastrointestinal bleeding
• Diarrhoea
• Ulcerative colitis
• Burst intestine
• Vomiting
• Constipation

Antibiotic side effects: Respiratory Risks

• Acute respiratory failure
• Respiratory arrest
• Blood clotting in lungs
• Shortness of breath
• Pulmonary oedema hiccough

Antibiotic side effects: Muscular & Skeletal Risks

• Tendon seizure
• tendon bursting
• tendon tears
• Jaw aches
• Arm or back pain
• Joint stiffness
• Neck and chest pain
• Gout

Antibiotic side effects: Renal & Urinary Tract Risks

• Kidney failure
• Calcification in kidneys
• Urethral bleeding
• Severe thrush
• Vaginitis

Antibiotic side effects: Epidermic Risks

• Anaphylactic shock
• Skin sloughing (falling off)
• Dermatitis

Thrush - Candida Albicans

Thrush, a disease caused by a fungus, affects the genitals and oral cavity, and is characterised by white, pasty patches. Small amounts of the candida fungus normally reside in your mouth and on your skin without causing problems, because their numbers are controlled by other bacteria. Some types of antibiotics can disturb this balance by killing the bacteria that control the fungus, causing the fungus to multiply out of control. As a general rule, the stronger the antibiotic, the worse the episode of thrush. Eventually, the thrush can become as persistent and almost as painful as the cystitis, because the fungus builds up resistance to treatments you use against it.

Symptoms of Thrush can include:

• Vaginal pain.
• Soreness and irritation, topical or internal.
• White curd discharge.
• White fungal spots around the vagina.
• Reddening of the vulva (the outer parts of the vagina).
• Itching around the vagina (infectious vaginitis).
• Swelling of surrounding tissues.
• Indigestion from candidiasis (leaky gut syndrome)
• Arthritis like symptoms.
• Sudden weight loss or gain
• Tiredness.
• General malaise.
• Pain during sexual intercourse.

Vasculitis

Vasculitis, inflammation of the blood vessels, is one of the listed side effects of some broad spectrum antibiotics commonly used for the treatment of cystitis. It is caused by immune reaction that can disrupt DNA and RNA, and put white blood cells on the attack against your own body. Lupus-like effects are reported.

Symptoms of Vasculitis can include:

• Red or purple dots, usually most numerous on the legs. When the spots are larger, about the size of the end of a finger, they are called "purpura." Some look like large bruises. These are the most common vasculitis skin lesions, but hives, itchy lumpy rash, and painful or tender lumps may also appear. Areas of dead skin can appear as ulcers. Small black spots appear at the ends of the fingers or around the fingernails and toes, or you may get gangrene of the fingers or toes.
• Aching in joints and obvious arthritis with pain, swelling and heat in joins. Deformities resulting from this arthritis can occur but are rare.
• Vasculitis in the brain can cause many problems, from mild to severe. They include headaches, behavioural disturbances, confusion, seizures, and strokes. May be fatal.
• Peripheral nerve symptoms may include numbness and tingling (usually in an arm or a leg), loss of sensation or loss of strength, particularly in the feet or hands.
• Vasculitis can cause inadequate blood flow in the intestines, resulting in crampy abdominal pain and bloating. If areas in the wall of the intestine develop gangrene, blood will appear in the stool. If the intestinal wall develops a perforation, surgery may be required.
• Vasculitis may affect the coronary arteries. If it occurs, it can cause a feeling of heaviness in the chest during exertion (angina), which is relieved by rest. Heart attacks rarely occur as a direct result of vasculitis.
• Vasculitis in lung tissue can cause pneumonia-like attacks with chest x-ray changes that look like pneumonia, and symptoms of fever and cough. Occasionally, inflammation can lead to scarring of lung tissue with chronic shortness of breath.
• Vasculitis can involve the small blood vessels of the retina. Sometimes, vasculitis of the eyes causes no symptoms. Usually, however, there is visual blurring which comes on suddenly and persists, or a person may even lose a portion of their vision. In temporal arteritis, there is sudden loss of part or all of the vision in one eye, usually accompanied by severe headache.

References

Lucas MJ, Cunningham FG: Urinary tract infections complicating pregnancy. In: William's Obstetrics. 19th ed. 1994: 1-15.

H.M.I. Osborn, J.J. Gridley, "Recent advances in the construction of beta-D-mannose and beta-D-mannosamine linkages", J. Chem. Soc., Perkin Trans. 1, 2000, 1471-1491.

Schieve LA, Handler A, Hershow R: Urinary tract infection during pregnancy: its association with maternal morbidity and perinatal outcome. Am J Public Health 1994 Mar; 84(3): 405-10.

Sweet RL, Gibbs RS: Urinary tract infection. In: Infectious Disease of the Female Genital Tract. 3rd ed. 1995: 429-64.

CDC Special Report: "Emerging Mechanisms of Fluoroquinolone Resistance" David C. Hooper Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Fuchs S, Simon Z, Brezis M: "Fatal hepatic failure associated with ciprofloxacin" Lancet 242:738-739 (1994).

InsightsandOutcomes.com - Article 194 : Health Researchers, Physicians Express Concern About Rising Antibiotic Resistance.