# Antibiotics increase functional abdominal symptoms.



## eric (Jul 8, 1999)

FYIAm J Gastroenterol 2002 Jan;97(1):104-8 Related Articles, Books, LinkOut Antibiotics increase functional abdominal symptoms. Maxwell PR, Rink E, Kumar D, Mendall MA. Department of General Practice and Primary Care, St George's Hospital Medical School, London, United Kingdom. OBJECTIVES: Data suggest that subjects with irritable bowel syndrome are more likely to report a recent course of antibiotics. This study tests the hypothesis that a course of antibiotics is a risk factor for an increase in the number of functional bowel complaints over a 4-month period in a general population sample. METHODS: We initiated a prospective case-control study in three general practices in South London. Consecutive patients aged 16-49 attending their general practitioner with non-GI complaints and given a prescription for antibiotics were invited to participate. Comparison subjects who had not had antibiotics for 1 yr were identified from the practice records by age group, gender, and previous general practitioner visits. Fifty-eight antibiotic and 65 control patients agreed to participate. Questionnaires covering demographic, GI, and psychological data were sent at recruitment and at 4 months. Seventy-four percent of subjects completed the study. The number of symptoms at follow-up compared to that at recruitment. RESULTS: Twenty of 42 antibiotic subjects (48%) versus 11/49 control subjects (22%) demonstrated one or more additional functional bowel symptoms at 4 months (unadjusted odds ratio = 3.14 [1.27-7.75]) (chi2 = 6.4, p = 0.01). Ten of 42 antibiotic subjects (24%) versus 3/49 control subjects (6%) demonstrated two or more additional functional bowel symptoms at 4 months (unadjusted odds ratio = 4.79 [1.22-18.80]) (chi2 = 5.8, p = 0.02). CONCLUSIONS: Functional bowel symptoms come and go, but subjects who are given a course of antibiotics are more than three times as likely to report more bowel symptoms 4 months later than controls. PMID: 11808932 [PubMed - in process]


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## mitchell goldstein (Apr 6, 1999)

this study is inconclusive, incomplete and not totally applicable here for our purposes. the following issues have helped me arrive at my conclusion:1. the subjects as i read it are not people with long standing ibs but a cross section of the general population who have experienced functional bowel problems post antibiotic therapy.2. no placebo or other medications were used in this study in an effort to completely indict or exonerate antibiotics. 3. every medication known to mankind has a myriad of gastrointestinal side effects reported with their usage. do we know how they would perform down the road?4. to the best of my knowledge(which is very far from authoritative)bacteria may or may not play a role in ibs; if bacteria were to play a role then antibiotic therapy may help at random. from experience i can say that i have done marvelously well with complete amelioration of my symptoms while on antibiotics and i have done very poorly at other times while on that same antibiotic.5. 10/42 and 3/49 are not very large or impressive numbers. if the non antibiotic sample has complained of g.i. symptoms how do we know that the g.i. complaints presented by the antibiotic group are caused by the medication or just random, viral or for similar reasons to the other group? i'm sure there are other issues invalidating this study but i don't have the brain power or patience to come up with them. if there were one medical discovery that we could credit with dramatically increasing the life span of all treatable mammals on this planet it would be the discovery of penicillin and its descendant antibiotics and antibacterials. although overprescribed they are not to be feared but to be taken with joy when given to you by a physician that you trust. a sharp doctor may in fact prescribe antibiotics(or other medication for that matter)for you for reasons that your untrained and uneducated mind can not comprehend. don't let inflated self confidence or advice from individuals not capable of rendering it dissuade you from following your doctors orders. you certainly have the right to question your doctor but you may not be able to follow his rationale. your doctor may even be prescribing a medication for you because of his experience or pardon the term " gut feeling ". if you don't trust your doctor find another one but while under his care try to play on the same team. much to the detrement of the people health care has evolved into a big business. doctors should be doing only what's right for their patients and not require and mba to succed in the medical world. when doctors and lay people treat health care like a cash cow we all suffer greatly.


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## flux (Dec 13, 1998)

> quote:this study is inconclusive, incomplete and not totally applicable here for our purposes. the following issues have helped me arrive at my conclusion:


The study (really an abstract: I've only read the abstract as posted above) has a reasonable conclusion and seems to be reasonable complete for what it looked at, and it is *very relevant*. Even studies like Pimental's which seem to be based on flawed data are relevant. We constantly need to be checking what we think and virtually all studies do that.


> quote:1. the subjects as i read it are not people with long standing ibs but a cross section of the general population who have experienced functional bowel problems post antibiotic therapy.


For one thing, why is this a bad thing? In fact, it might be a good thing. How does IBS begin? This study may given us a hint at a way that science has previously not addressed. The only point that I see relevant is that what the reasons why antibiotics were given? Were there any cases of GI infections?


> quote:2. no placebo or other medications were used in this study in an effort to completely indict or exonerate antibiotics.


Technically, this is correct, the control subjects did not appear to be given any dummy pills. But for now, that's not a terrible problem because there is kind of control. Contrast this with the Pimental study were there was no control of any kind.


> quote:3. every medication known to mankind has a myriad of gastrointestinal side effects reported with their usage. do we know how they would perform down the road?


Why choose antibiotics to look at? Because many people take it and they take it for a short time and stop taking it. There aren't that many other drugs in that category. Sure people take aspirin but they probably do so for a much shorter time and over a longer time..they never really stop. Remember, they are looking for effects long after a person has stopped taking the antibiotics.Besides, we have a good reason to think antibiotics mess with the gut.. The gut is full of bacteria and antibiotics kill bacteria..


> quote:4. to the best of my knowledge(which is very far from authoritative)bacteria may or may not play a role in ibs


I'm not sure of the point here..the study isn't suggesting one way or another here..only that antibiotics may be associated with functional bowel symptoms..an answer to that based on the perspective of the study is several studies on down the road.


> quote:5. 10/42 and 3/49 are not very large or impressive numbers.


When do we ever see impressive numbers anywhere? That's what we have statistics for.


> quote:if the non antibiotic sample has complained of g.i. symptoms how do we know that the g.i. complaints presented by the antibiotic group are caused by the medication or just random, viral or for similar reasons to the other group?


This is what p value is supposed to tell us.. at least for the random part..but you are probably technically right about someone getting a gastroenteritis it could have happened either group.. the statistics of course is supposed to help us with that (that's doesn't necessarilly mean it does). The Pimental study was an example of a truly poorly done study.. no control group whatsoever, poor data interpretation which had been based on an relatively unreliable test..This study is not by any means a landmark study (nor does it attempt to be).. but I don't feel terribly concerned that is as poor as the other poster is claiming it to be.Now Eric is that a *fast* editorial or what?


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## trbell (Nov 1, 2000)

the abstract doesn't say anything about gender but since it's another study based on people who see the doctor I would assume it's predominantly women (does anyone have a hospital library nearby that can actually read the article.women tend to see doctors, women tend to report functional gastro symptoms, and women tend to take antibiotics, so I have to agree that the article doesn't really say toomuch of interest.tom


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## flux (Dec 13, 1998)

> quote:women tend to see doctors, women tend to report functional gastro symptoms, and women tend to take antibiotics, so I have to agree that the article doesn't really say toomuch of interest.


This sounds like a *straw man* argument.Since we don't know (from what's given in the abstract) the gender makeup, why assume the control group did not control for that variable? If your assumption is wrong, your logic won't hold up. Further, is true to say that women tend to take antibiotics more than men? On top of that, women tend to get IBS by a ratio of three to one over men (at least everywhere except India) anyway, so having both study groups consist mainly of women wouldn't automatically be a bad idea.


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## eric (Jul 8, 1999)

Wow, I just posted it precautionary wise and because it fits some resent conversations and because it really wasn't a positive route and caution is advised.Thanks for the breakdowns though.Nice to see you guys are always on it.


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## bonniei (Jan 25, 2001)

> quote:The only point that I see relevant is that what the reasons why antibiotics were given? Were there any cases of GI infections?


chest infection:28Ears, nose, throat 13skin sepsis:7urinary tract infection:5others 5


> quote:I would assume it's predominantly women


Ratio of Male to Female 10:32 for antibiotic group and 15:34 for control groupOn all other factors like age, GP visits in the previous year, depression, hypochondriasis, disease phobia, bodily preoccupation, proportion fulfilling Rome criteria for IBS at baseline the antibiotic group was remarkably well matched with the control group.Thanks for the study, eric.flux,this editorial was remarkably quick. We are all waiting for the editorial on Pimental's study


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