TWIL: Probiotics

So the doctor at the urgent care clinic said, "If you do end up having a bladder infection after we do this culture test, you'll take an antibiotic, but be sure you take probiotics with it."

"Probiotics? With Antibiotics?" I said, thinking, wouldn't they cancel each other out?

"Yes," the doctor said, "Because if you don't, you run the risk of getting C. diff."

I recoiled. Even though I am mentally prepared that if I get C. diff I am offering myself up for the fecal transplant day one, because that's the only thing that's ever cured it in any of the cases I know about.

I have never heard of this before, but I think that's because this doctor was thinking of prescribing an antibiotic I don't usually get. And that's all my fault, because when the Nurse Practitioner asked if I had any allergies, she didn't say drug allergies, and I thought food allergies. 

So really, what I learned this week is that some doctors recommend probiotics with antibiotics, and that even though your regular doctor is 30 minutes further away go there because they know your sulfa and penicillin DRUG allergies without asking, and that even if you feel like you have a bladder infection you might not.

Comments

[KC]

Yep, probiotics to keep your GI bacteria count up with the good ones, if you take broad-spectrum oral antibiotics that will otherwise make a huge dent in your gut microbiome (I have found that otherwise there are Digestive Regrets with ciprofloxacin, although I've never had C. diff-sized regrets). Offsetting the times, though, so the probiotics "follow" the antibiotics.

Also yes, do not take medications you're allergic to. Sigh.

[theQueen]

KC - i took probiotics and prebiotics for a while but saw no effect.

[KC]

You may have an unusually robust gut microbiome? If you don't normally get gut problems with broad-spectrum antibiotics - or if you don't normally *take* broad-spectrum antibiotics - then it's probably good enough without them (although honestly the major changes to 1. metabolism and 2. depression that can be induced by a fecal transplant are bizarre and fascinating).

Oh, also probiotic foods can give things an edge without needing pill probiotics: yogurt, kimchee, etc. And all sorts of things are natural prebiotics, again, without needing them in capsule form.

But also some peoples' guts have a more healthy, less disruptive work ethic than others. So.

[theQueen]

KC - oohhh - depression and fecal transplants sounds fascinating. And I do start almost everyday with yogurt,

[KC]

Yeah, there's a lot of really phenomenally weird stuff in there! Depression sort of makes sense, since your gut does so much serotonin production, but still: weird. If it wasn't that every so often a fecal microbiome transplant got C. diff, they'd probably be legal for more uses in the US than they are. (but: if you kill off someone's gut microbiome, a lot of stuff happens, including a susceptibility to c. diff significantly in excess of the susceptibility caused by taking a normal broad-spectrum antibiotic because that doesn't kill off your *whole* gut microbiome! and then there are other risks of bowel perforation, etc., so it's basically down to "is this very likely to kill you immediately? yes? then you can have a fecal transplant. Is it not? NOPE." which is clinically reasonable to some degree but has some shortcomings...)

(we also just don't know a lot about it; it's extremely expensive to do genetic sequencing *and* what you get from proportional-bug genetic sequencing isn't necessarily continuously representative due to foods, etc.; and we don't have an "ideal" or even know whether the ideal is the same for all the people or whether it's partly individual based on other body/brain factors; we don't know all that much about how to establish oral probiotics as residents rather than tourists in our gut [other than prebiotics]. Etc. But: it's very promising as a field of inquiry, and therefore it's also very promising as a field of quackery, sigh.)

[theQueen]

KC - I know someone with an allergic reaction to anti-biotics, not a bowel reaction, but full-on hallucinations. I suppose if serotonin is involved ...