Misuse of Antibiotics

To the growing list of undesirable side effects resulting from treatment with antibiotics, Manhattan's Dr. Jerome Weiss last week added one that most patients may prefer not to talk about, though it can be both painful and serious: antibiotic diarrhea. It is, Weiss told the Michigan Academy of General Practice in Detroit, "a new entity." Besides high frequency of bowel movements, symptoms include distressing itching around the anus, nausea, vomiting and severe abdominal cramps.

Any antibiotic--perhaps any drug used to kill bacteria--might cause this disorder said Dr. Weiss, but most often to blame are the "broad-spectrum" antibiotics such as aureomycin, terramycin, Chloromycetin. The doctor may be using these wisely against an infection for which they are known to be effective, or unwisely against virus" diseases in which they are not likely to be of any use. Either way the antibiotics kill off many of the bacteria normally found in a healthy intestinal tract. In so doing, they disturb the balance of nature and leave the depopulated gut as a breeding ground for yeastlike fungi, especially one called Monilla (or Candida) albicans.

"The patients were assured by their physicians," said Gastroenterologist Weiss "that the upset and pruritus [itching] were only temporary and would subside. After a week of these distressing symptoms, they would be given some of the routine pectate preparations and more reassurance. By the end of the third week after having been starved, given anti- spasmodics and various internal and external medications to no avail, they sought the aid of the gastroenterologist."

In some cases, especially where the trouble was a simpler disturbance in the balance of ordinary colon bacilli, Dr. Weiss found that acidophilus milk did the trick. More often, however, he had to use an ion-exchange resin with silicates (Resion) and eventually had to beef this up with phthalysulfacetamide, an intestinal antiseptic, and--ironically--another antibiotic, Polymixin-B.

The intestine is not the only organ troubled by the Monilia fungus. This microorganism was first found in the throat (in cases of thrush), also occurs regularly in the vagina. Many women who take aureomycin or related antibiotics develop a stubborn inflammation of the vagina and perineal region. Sometimes the organism spreads over large areas and reaches the lungs or brain heart or kidneys. There have been cases in which a child's entire body has been covered with itchy inflammation. In treating such cases of moniliasis, still another antibiotic has been found to help undo the harm wrought by other antibiotics--nystatin (Mycostatin), which has come into general use only this year.

Too often, doctors give antibiotics to victims of virus infections, in the vain hope that they may do some immediate good, and to ward off a later infection by the bacteria moving in on weakened tissues.

The Food & Drug Administration's Barbara Moulton warned a fortnight ago that this is bad on two grounds: 1) there is evidence that some beneficial bacteria destroy harmful viruses, so they should be given every chance, not wiped out by antibiotics; 2) by no means every viral disease carries the danger of secondary bacterial infection. Antibiotics, she insisted, may actually delay recovery in cases of the common cold, influenza, polio mumps and herpangina (a kind of sore throat). So they should be used only where there is a clear and positive need for them.

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