Antibiotics: Overview

Alternative names: Antibacterials

Antibiotics are medications that destroy or slow down the growth of bacteria.  A healthy immune system, using specialized white blood cells, can usually destroy harmful bacteria before they can multiply and cause serious symptoms.  However, bacteria can sometimes overwhelm the immune system and that's when antibiotics become essential.

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Antibiotics have significantly extended the average human lifespan since their introduction in the late 1930s.  Before antibiotics, a simple cut or scrape could develop into an uncontrollable and fatal infection.  Wounds and burns infected with streptococcus or staphylococcus bacteria were major causes of death, as were the bacteria that cause tuberculosis and pneumonia.


The first antibiotic was penicillin, from which related antibiotics such as ampicillin and amoxicillin were developed in order to reduce side-effects and cope with antibiotic-resistant bacteria.  Other non-penicillin-related antibiotics have now been developed, but development is not keeping pace with the spread of multidrug-resistant strains of bacteria.

Function; Why it is Recommended

There are many types of antibiotic drug, but they all work in one of two ways: Bactericidal antibiotics such as penicillin kill the bacteria, usually by interfering with the formation of the bacterium's cell wall or contents.  Bacteriostatic antibiotics prevent bacteria from multiplying.

Broad-spectrum antibiotics can be used to treat a wide range of bacterial infections, whereas a narrow-spectrum antibiotic is only effective against a few types of bacteria.  Some antibiotics attack aerobic bacteria, while others fight anaerobic bacteria.

Bad bacteria not only cause infected wounds, but also illnesses such as pneumonia, certain sexually-transmitted diseases such as syphilis, and tuberculosis, salmonella, and meningitis.  Antibiotics are highly effective against all of these.

Before treating an infection, it is important to know whether it is caused by bacteria or a virus.  Antibiotics do not work against viruses.

Antibiotics may be used to prevent infection, for example prior to surgery.


Antibiotics are usually taken orally, but they can also be injected or applied directly to the affected part of the body.  A course of antibiotic treatment usually lasts from 7-10 days, but may last much longer – for example in the case of tuberculosis.  A dose is usually taken once every 6, 8 or 12 hours.

Certain antibiotics should not be consumed with certain foods or drinks.  Others need to be taken with an empty stomach, usually about an hour before meals, or two hours after.  It is important to follow directions in order to ensure maximum effectiveness of the treatment.  Metronidazole should not be consumed with alcohol; tetracyclines should not be used with dairy products.

Antibiotics often start to have an effect within a couple of days, or even a few hours, but this does not mean that the treatment should be stopped: always complete a course of antibiotic treatment to ensure the best chance of a total cure, and to reduce the possibility of developing drug-resistant bacteria.

Something to keep in mind whenever using antibiotics is that they may be more effective when taken with bromelain.  In humans, some undetermined activity of bromelain has been documented to increase blood and urine levels of antibiotics.  Combining bromelain and antibiotic therapy has been shown to be more effective than antibiotics alone in treating a variety of conditions including pneumonia, bronchitis, staph skin infections, thrombophlebitis, cellulitis, pyelonephritis, perirectal and rectal abscesses, and sinusitis. [Drugs Exp Clin Res 1978;4: pp.45-8]

Expected Outcome; Side-Effects; Counter-Indicators and Warnings

After a course of antibiotics, make sure to repopulate your colon with friendly bacteria afterwards: use a broad spectrum probiotic to reintroduce good bacteria and thus keep pathogenic (bad) bacteria and yeast in check.

The most common side-effects of antibiotics include diarrhea (antibiotics disrupt the balance of gut bacteria), feeling sick, and fungal infections of the mouth, digestive tract or vagina.

Depending on the type of antibiotic being used, other less common side-effects include kidney stone formation, abnormal blood clotting, sensitivity to sunlight, blood disorders, or even deafness.  Ask about the possible risks prior to starting a course of antibiotic treatment, and then decide whether the potential risks are worth the expected benefits.  There are usually alternative antibiotics that can be used.

Some people are allergic to certain antibiotics – especially penicillins.  Side-effects range from rash, swelling of the tongue and face, and difficulty breathing, to very serious and even fatal anaphylactic reactions.  This is why your doctor or dentist should always ask if you have any known allergies to medications.

It should be remembered that the more we use antibiotics, the more resistant the bacteria become.  This is especially true when a course of antibiotics is abandoned part way through: Always complete a course of antibiotics as prescribed, even if it appears to have 'worked' early on in the treatment.

In August 2012, the International Journal of Obesity published a study showing that babies who are exposed to antibiotics have a greater risk of becoming overweight or obese during childhood.

Use extreme caution and tell your doctor if you have reduced liver or kidney function, or are pregnant or breastfeeding.

For women, certain antibiotics may reduce the effectiveness of oral contraceptives, especially if the antibiotic has caused diarrhea or vomiting.  Consider taking additional contraceptive precautions during antibiotic treatment.

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Antibiotics can help with the following:


Not recommended for
Alcohol-related Problems

Some antibiotics do not work well when combined with alcohol.


Rheumatic Heart Disease

People who have already had rheumatic fever are more susceptible to attacks and heart damage.  For this reason they are given continuous monthly or daily antibiotic treatment, perhaps for life.  If their heart has been damaged by rheumatic fever, they are also given a different antibiotic when they undergo dental or surgical procedures.  This helps prevent bacterial endocarditis, a dangerous infection of the heart's lining or valves.


Antibiotics are required for several weeks to fight infection.  Antibiotic treatment is often intravenous.

If you have heart valve damage or a heart murmur, request antibiotics prior to medical procedures that may introduce bacteria into the blood.  These include dental work, childbirth and surgery of the urinary or gastrointestinal tract.


IBS (Irritable Bowel Syndrome)

Research suggests that IBS can be caused by an unhealthy imbalance of gut bacteria (Small Intestinal Bacteria Overgrowth or SIBO).  Non-absorbable antibiotics were found to:

  • help normalize the bacterial balance
  • make harmful bacteria less dangerous
  • reduce inflammation
  • preserve healthy bacteria in the colon
  • protect the intestinal lining from bacterial infection
Clostridium Difficile Infection

Even though this disease can be caused by long-term antibiotic use, and mild cases can often be treated by simply stopping antibiotic use, the main treatment for severe C. diff is, ironically, a 10- to 14-day course of antibiotics.  The antibiotics most commonly used are Flagyl (metronidazole), Dificid (fidaxomicin), or Vancocin (vancomycin).  Symptoms usually start to improve within 3 days.

Gastric/Peptic/Duodenal Ulcers

While the mechanism of how H. pylori causes ulcers is not well understood, its elimination by antibiotics has clearly been shown to heal ulcers and prevent ulcer recurrence.


Antibiotics are used to treat H. pylori and should be used to treat other bacterial overgrowths in the stomach as well.  Since these overgrowths are usually responsible for the inflammation, eradication allows the stomach to heal and normal acid-control mechanisms to be restored.

Bacterial Dysbiosis

Antibiotic drugs may either cause or help control dysbiosis, depending upon the drug and the nature of the disorder.  Where contamination of the small bowel by anaerobes is the problem, metronidazole or tetracyclines may be beneficial.  When enterobacterial overgrowth predominates, ciprofloxacin is usually the drug of choice because it tends to spare anaerobes.  Herbal antibiotics may be preferred because of their greater margin of safety and the need for prolonged antimicrobial therapy in bacterial overgrowth syndromes.

Eyes / Ocular


In most cases of adult or childhood conjunctivitis, treatment with topical antibiotics is initiated without cultures.  If the ophthalmologist elects for cultures, antibiotic therapy is usually initiated and treatment changed later, as necessary, depending on culture results.  Gonococcal conjunctivitis requires intravenous or intramuscular antibiotics in addition to topical therapy.


In cases where bacterial infection is a cause, eyelid hygiene may be combined with various antibiotics and other medications.


Vulvodynia / Vestibulitis

Vulvar pain that is due to infection e.g. ureaplasma, candida or strep will respond to the appropriate treatment.

Not recommended for
Susceptibility To Miscarriages

Antibiotics may be prescribed to treat infections in the mother, which can be a cause of miscarriages.



Antibiotics are used both to treat the infection and prevent it from returning.  The length of antibiotic therapy depends on the severity of the infection and on whether there are complications.

Lyme Disease

Current therapy involves the use of antibiotics, such as doxycycline or amoxicillin.

Urinary Tract Infection (UTI)

While natural means may prevent as well as treat cystitis, there are times when the judicious use of antibiotics is the best treatment choice.  Natural means alone will often prevent recurrence and in some cases resolve bladder infections that have resisted antibiotic treatment.


The organism is sensitive to antibiotics and treatment results in improvement in 24 to 48 hours.  Recovery takes 3 weeks.  Antibiotics that work for Lyme do not work against Ehrlichiosis.  Instead, doctors use drugs in the tetracycline family.  Tetracycline drugs can be used against Lyme, so some doctors cover both bases by prescribing tetracycline when the diagnosis is unclear.

Whooping Cough (Pertussis)

Antibiotics such as erythromycin help if the disease is diagnosed early.  However, most patients are diagnosed too late, when antibiotics are no longer effective except in helping to reduce the patient's ability to spread the disease.

Boils, Abscesses, Carbuncles

Boils often resolve by themselves, but severe or recurring cases require medical treatment.  Options include lancing and draining the boil, or antibiotics.  If there is an infection of the surrounding skin, a doctor may decide to prescribe antibiotics.  However, antibiotics are not needed in every case and, in fact, do not enter an abscess well and will not cure an abscess.  For acne and hidradenitis suppurativa, antibiotics may be required on a long-term basis to prevent abscess formation.  In cases of multiple or recurrent boils, antibiotics are taken by mouth for 10 or 14 days.  Stubborn cases may require two oral antibiotics plus topical antibiotic ointments to eliminate the bacteria.

Gulf War Illness

Scientists at The Institute for Molecular Medicine have found that slightly under one-half of the very sick Gulf War Illness patients in a pilot study with the signs and symptoms of Chronic Fatigue Syndrome or Fibromyalgia have chronic invasive infections involving certain uncommon mycoplasmas, such as Mycoplasma fermentans (incognitus strain).  This has now been confirmed in a large Department of Defense – Department of Veterans' Affairs clinical trial.

Staff at The Institute for Molecular Medicine have recommended that these infections can be successfully treated with certain antibiotics, allowing the recovery of patients who have been long-term disabled.  Similarly, in ongoing preliminary studies on Chronic Fatigue Syndrome and Fibromyalgia patients, we have found that a subset of patients have mycoplasmal infections that can be successfully treated with antibiotics, allowing patients to recover from their illnesses.

Pharyngitis ("Strep Throat")

Primary care physicians should avoid or delay prescribing antibiotics to patients with sore throats.  Even when beta-hemolytic streptococcus has been cultured and thus shown to be present, antibiotic use may be no more effective than placebo. [Antibiotics are Ineffective for Sore Throat Treatment, Family Practice News, May 25, 1997; p.62, British Medical Journal, 1997;314: pp.722-27]

When antibiotics are required, a once-daily regimen of amoxicillin was found to be as effective as penicillin V administered tid to children with group A beta-hemolytic streptococcal pharyngitis.  This reduces cost and inconvenience.

Lab Values


Patients developing fever during neutropenia require treatment with intravenous antibiotics and occasionally admission to the hospital until the neutrophil blood cells return to sufficient levels in the blood to fight the infection.

Organ Health

Consequences of Splenectomy

In order to reduce further the small risk of serious infection, a person who has undergone splenectomy will need to take antibiotics for the rest of their life.  In most cases this will be penicillin, but those allergic to it will be given some other form of antibiotic.  It is important also to recognize minor infections before they become serious.  If there is any sign of infection (for example raised temperature, sore throat, unexplained cough, abdominal pain and/or headache with drowsiness or a rash), a doctor should be contacted.


Giardiasis Infection

Antibiotic use may best be reserved for cases that fail to respond to initial treatment with natural measures.  Because of the increased risk of side-effects and the possible emergence of antibiotic-resistant organisms, metronidazole, tinidazole, or benzimidazole antibiotics may best be reserved for cases in which the primary non-antibiotic treatment program is ineffective.  In particular, metronidazole has been associated with recurrence rates as high as 90%, and the prevalence of clinical metronidazole-resistance may be as high as 20%.


STD Syphilis

The gold standard for treatment of syphilis is consecutive daily intramuscular injections with procaine penicillin.  The dosage and duration of treatment are determined by the clinical presentation, e.g. chancre, secondary mucocutaneous manifestations, neurosyphilis, etc.

If no clinical staging is possible (as is usually the case), serological staging determines the treatment regime.  There are a number of treatment options for patients who are allergic to penicillin, who are needle-phobic or who may not comply with a course of daily injections.  These treatment options have not been as well studied as the procaine penicillin regimes but are totally acceptable alternatives.

Benzathine penicillin as a single injection will adequately treat primary and secondary syphilis, or seropositive syphilis with a VDRL or RPR titer of 1:16 or higher.  This regime is much more user-friendly than a 10-day use of intramuscular procaine penicillin and compliance is not an issue.  This same dose can be given to sexual contacts of the above groups as epidemiological treatment.  Because benzathine penicillin does not cross the blood-brain barrier it is only suitable for treating latent syphilis (VDRL or RPR titer < 8) if the C.S.F. is normal.  Benzathine penicillin does cross the placenta and is therefore suitable for treating pregnant women with early syphilis.

Non-pregnant patients allergic to penicillin may be treated with doxycycline 300mg daily for 21 days.  This regime is considered adequate for treatment of early and late disease, whether symptomatic or latent.  This regime would also be appropriate for needle-phobic patients, as would oral amoxycillin 3gm twice daily with 1gm of probenecid for 2 weeks.


Erythema Nodosum

Some experts suggest treating all cases with penicillin (if penicillin was not the underlying cause), because strep infection is frequently the underlying condition.

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