Are antibiotics safe for teenagers - What to expect?

Do you find yourself reaching for an antibiotic every time your kids catches a cold? Is it as safe as you think? Dr Subramanian Swaminathan explains the effects of antibiotics on your teenager.

At the time of birth, the human body is sterile- it has no bacteria in the system, and with the first breath and first feed, bacteria reach the breathing and intestinal passage respectively. Most people may be unaware that this is vital not only for their well-being but also for survival. These bacteria play a vital part in our health and defence against diseases.

We have a close relationship with the microbes in various parts of the body such as the skin, mouth and digestive tract. This is known as the microbiome. The balance of bacteria in these areas is unique for each person and is continuously evolving in response to changes in the environment and the person as well. For the most part, these changes are of minimal consequence and do not adversely affect the person. However, some changes have now been associated with dysbiosis- a change which can result in harm to the person.

Why Do We Need Bacteria?

For the most part, many of us are aware that there are "good bacteria", or what is healthy for us. Many consume such preparations routinely, although the value of this is unclear. It helps in maintaining the skin, preventing the overgrowth of harmful bacteria, and sometimes aid the immune system as well. In the intestine, some of these bacteria help in digestion of substances which we may otherwise struggle with. This niche is so finely balanced that changes in it have been associated with the development of disease in various organ systems.

We Are The Most Vulnerable In Younger Age

Although we are vulnerable to changes in the microbiome in every phase of life, the time when we are most vulnerable is in our younger age, in periods of active growth. Teenagers face multiple challenges. They are now exploring the world more than ever, making them come into contact with more bacteria they are not used to earlier.

They are experimenting with food, which can also induce a change in the intestinal microbiome; changes in their hormone level also changes the way every organ system works, including their intestines and skin (which is one reason why acne is so common in that age). Unfortunately, another variable has entered this equation, and that is the modification due to antibiotics, which can sometimes be harmful.

Antibiotic use in India is rampant and often indiscriminate. Doctors often feel pressured to give such agents for all routine fevers, and parents are often under the mistaken impression that these are harmless. There is certainly a role for antibiotics in selected situations, but the amount of use today is certainly much higher than what it was a generation ago. Furthermore, many do not realize that the bulk of the antibiotic use is in the veterinary and animal husbandry industry and this often makes its way into the food chain and onto our tables. Some parents have now recognized this challenge and have moved on to using only organic produce, but oversight to ensure compliance can be an issue.

What are the adverse effects attributable to antibiotic use?

The first issue is the development of drug resistance, and this is taking on nightmare proportions. A study from the UK has shown that if two or more courses of antibiotics in a year, that antibiotic becomes ineffective 30% of the time when reused the next year. This means that the doctor now has to use more expensive or toxic drugs, which can harm the person.

Another study has shown that every course of antibiotics increases the risk of the child developing Inflammatory Bowel Disease (IBD)- by 6%, and this risk is additive. In fact, the importance of the intestine-brain axis is a hot topic for research and the effect of alterations of the microbiome and risk of many problems like asthma, allergy, bowel and metabolic disorders is being studied. There is enough material for health professionals to recommend that taking care of the microbiome is essential for long term wellbeing.

Do Not Ignore The Side Effects Of Antibiotics

Finally, the side effects due to medications are being underestimated. In 2018, the US Pediatric Infectious Diseases Society estimated that antibiotic-related side effects resulted in nearly 70,000 emergency room visits every year. This is no small number, and we do not have comparable estimates for our country, but there is no reason for it to be significantly different, given the way we have imbibed the bad practices of the Western world.

In summary, promoting a healthy lifestyle is vital for long term well-being, and abuse of antibiotics is an important detractor in this effort.

(Authored by says Dr Subramanian Swaminathan, Director, Infectious Diseases, BGS Gleneagles Global Hospital, Bengaluru)