Comments on the Link between Childhood Antibiotic Use and Asthma
By Dr. Michael Murray

Introduction

While antibiotics definitely save lives and are truly miraculous at times, there is no question that physicians and patients need to reduce the excessive reliance on and abuse of these drugs. Over dependence on antibiotics is creating many problems including the development of “superbugs” that are resistant to currently available antibiotics as well. According to many experts as well as the World Health Organization we are coming dangerously close to arriving at a “post-antibiotic era” where many infectious diseases will become resistant to conventional antibiotics.

There are other consequences from this over reliance on antibiotics as just this week it was reported in a major medical journal that early antibiotic use was linked to an increased risk for developing childhood asthma (discussed in full below).1

The major reasons why kids are placed on antibiotics is in the treatment of bronchitis, ear infections, and other upper respiratory infections. Is this practice appropriate? No and not according to me, but by the very organizations that provide guidelines and recommendations to pediatricians and other medical doctors. Let’s take a look at the use of antibiotics in acute bronchitis and ear infections before discussing the link with asthma.

Antibiotics and Acute Bronchitis

Over the past twenty years there have been several randomized controlled trials designed to assess the benefit of antibiotics in acute bronchitis. Despite sufficient data (now more than a dozen double-blind studies) showing no clinical benefit for antibiotics in acute bronchitis, these drugs are prescribed by virtually every doctor encountered with a patient presenting with acute bronchitis. This practice is also in direct conflict with the practice guidelines from the American College of Chest Physicians – the medical specialty that deals with bronchitis and other respiratory disorders. According to their most recent guidelines “The widespread use of antibiotics for the treatment of acute bronchitis is not justified, and vigorous efforts to curtail their use should be encouraged.”2 Nonetheless, roughly 70% of doctors regularly prescribe an antibiotic for acute bronchitis even though it provides no benefit and significant risk. The risks include overgrowth of Candida albicans, disruption of normal gut microflora, and the possibility of developing antibiotic-resistant strains of bacteria.

Why do physicians prescribe antibiotics for acute bronchitis in light of the scientific facts? There are several misconceptions according to an editorial title “What will it take to stop physicians from prescribing antibiotics in acute bronchitis? “that appeared in the medical journal The Lancet. There is no data to support the use of antibiotics when a patient’s history is “I’ve had a cough for a week, and now my phlegm has turned green.” Likewise, there is no data to support the use of antibiotics because of a fever in acute bronchitis or in the hop of preventing potential progression to pneumonia. Another reason why doctors prescribe antibiotics for acute bronchitis is that many patients believe only an antibiotic can cure acute bronchitis. This belief is perhaps best exemplified by the fact that in one double-blind study, 60% of eligible patients refused to enter the study because they felt that antibiotics were absolutely necessary. Given the doctors’ and patients’ beliefs and expectations, it is little wonder that antibiotics continue to be prescribed for a condition in which they will not alter the course and are never warranted.

Antibiotics and Ear Infections

The major source of antibiotic use in childhood is the misguided believe that they are necessary in the treatment of ear infections. A number of well-designed studies and detailed analyses have demonstrated that there were no significant differences in the clinical course of acute ear infections between children treated with antibiotics or given a placebo.3,4 Interestingly, in some studies, children not receiving antibiotics did have fewer recurrences than those receiving antibiotics. This reduced recurrence rate is undoubtedly a reflection of the suppressive effects antibiotics have on the immune system, as well as disturbing the normal flora of the upper respiratory tract. Despite the data showing little, if any, benefit from antibiotics in ear infections, 98% of children presenting with an ear infection to a doctor in the United States are given an antibiotic.5

WARNING: Although antibiotics may not be statistically effective, each child must be evaluated individually with appropriate clinical evaluation and follow-up before in order to judge the appropriateness of antibiotic therapy.

Asthma – a Consequence of Antibiotic Use?

Asthma rates in children have doubled in the last 10-15 years – why? Well, in a combined analysis of seven studies involving more than 12,000 youngsters, researchers at the University of British Columbia found that those prescribed antibiotics before their first birthday were more than twice as likely as untreated kids to develop asthma. And, if they had multiple courses of antibiotics it bumped up the risk even higher — 16 per cent for every course of the drugs taken before age one.

O.K., there is no question that antibiotics have their place in medicine – they definitely save live. But, here is my point: the majority of these kids that may have developed asthma from antibiotic use were given them for conditions (e.g., bronchitis, ear infections, colds, etc.) where antibiotics have not been shown to be effective.

There are a couple of explanations for this association between antibiotic use and asthma – one is that antibiotics contribute to a state of “excess hygiene” leading to a reduced exposure to microbes leading to an over-sensitive immune system, which mounts an over-the-top allergic reaction to pollen and dust mites leading to asthma.

My feeling is that the underlying mechanism explaining a possible link between antibiotic use and asthma is the negative effect that antibiotics have on the normal flora gastrointestinal and respiratory passages. Recent clinical studies have shown that giving probiotics (active cultures of beneficial bacteria like Lactobacillus and Bifidobacteria species) lowers the risk of allergic disease like asthma and eczema. These results definitely points to antibiotics actively raising the risk by wiping out these beneficial bacteria.

What's a Parent to Do?

The key point that I want to make here is that the best medicine is always prevention, helping your child build a strong immune system is the primary goal. Breastfeeding for at least the first four months of life, avoiding food allergies and airborne irritants (like cigarette smoke), and providing optimum nutrition are all very important in helping children develop greater resistance to infections. And, when illness does present itself, visiting a naturopathic physician (please go to www.naturopathic.org to find an N.D. in your area) for natural support should be the first stop.

In the treatment of acute ear infections, ear drops containing various herbal medicines have been shown to be very effective in reducing pain and calming a crying child. For example, in a double-blind trial in 171 children ages 5 to 18 were randomly assigned to receive treatment with naturopathic herbal extract ear drops (NHEDs) or anesthetic ear drops (amethocaine and phenazone), with or without amoxicillin (80 mg/kg/day).6 The NHEDs contained a combination of extracts of marigold flowers (Calendula officinalis), St. John’s wort (Hypericum perforatum), and mullein flowers (Verbascum thapsus) in olive oil with the essential oil of garlic (Allium sativum) and was dosed at 5 drops in the affected ear three times daily. All groups had a statistically significant improvement in ear pain over the course of the 3 days, with a 95.9% reduction in the NHED-alone group. The NHED plus antibiotics had a 90.9% pain diminution. The anesthetic alone and anesthetic with antibiotics had 84.7% and 77.8% reductions, respectively. What this data indicates is that the topical treatment with the naturopathic approach was the most effective treatment.

Final Comments

For too long modern medicine has ignored the role of immune function in the infection equation. Each day we all are exposed to organisms that have the potential to make us sick, yet we don’t fall prey to these “bugs” because our immune system is stronger than the organism. If the organism is extremely virulent or our immune system is compromised, that is when an infection occurs. Conventional medicine has been obsessed with infective agent rather than host defense factors.

The obsession with killing the infective organism versus boosting immune function really began with Louis Pasteur, the 19th century physician and researcher who played a major role in the development of the germ theory. This theory holds that infectious organisms cause most diseases. Much of Pasteur's life was dedicated to finding substances that would kill the infecting organisms. Pasteur and others since him who pioneered effective treatments of infectious diseases have given us a great deal for which we all should be thankful. However, another 19th century French scientist, Claude Bernard, also made major contributions to medical understanding. Only Bernard had a different view of health and disease. Bernard believed that the state of a person's internal environment was more important in determining disease than the organism or pathogen itself. In other words, Bernard believed that the internal "terrain" or host susceptibility to infection was more important than the germ. Physicians, he believed, should focus more of their attention on making this internal terrain a very inhospitable place for disease to flourish.

Bernard's theory led to some rather interesting studies. In fact, a firm advocate of the germ theory would find some of these studies to be absolutely crazy. One of the most interesting studies was conducted by a Russian scientist named Elie Metchnikoff, the discover of the white blood cells. He and his research associates consumed cultures containing millions of cholera bacteria. Yet none of them developed cholera. The reason: their immune systems were not compromised. Metchnikoff believed, like Bernard, that the correct way to deal with infectious disease was to focus on enhancing the body's own defenses.
During the last part of their lives, Pasteur and Bernard engaged in scientific discussions on the virtues of the germ theory and Bernard's perspective on the internal terrain. On his deathbed, Pasteur said: "Bernard was right. The pathogen is nothing. The terrain is everything."

Unfortunately, Pasteur's legacy is the obsession with the pathogen and modern medicine has largely forgotten the importance of the "terrain." That perspective is slowly changing out of necessity.

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