Antibiotic-Induced Suprainfection

Introduction:

Antibiotics are considered medicines that kill bacteria and treat diseases. This is true but not the complete truth. The fact is antibiotics can also induce several infections. Many individuals frequently take antibiotics because, to the best of their knowledge, antibiotics can treat any disease, and they will get better with a disease if they take antibiotics. This misunderstanding has led to problems such as antibiotic resistance and antibiotic-induced superinfections. Suprainfections occur due to the wrongful use of antibiotics. This article addresses why taking antibiotics can result in these infections, how they are treated, and how they can be prevented.

What Are the Common Misconceptions about Antibiotics?

Several common misconceptions among people cause them to use antibiotics frequently, even in cases where antibiotics are not necessary. For example, misconceptions like antibiotics can kill any germ and treat any illness. This is not true. The fact is that antibiotics can kill only bacteria and not viruses or fungi. Therefore, illnesses caused by viruses and fungi cannot be cured by antibiotics. An excellent example is the seasonal flu caused by the influenza virus, for which people frequently take antibiotics that cannot kill the virus.

Another misconception is the duration of the course of antibiotics. It is not true that taking antibiotics more than required will enhance their antibacterial activity. Antibiotics should not be taken without a prescription for a longer duration. This is because there are various antibiotics, and only a physician can determine what is appropriate for a specific condition. Therefore, the unnecessary use of antibiotics is not good for health.

What Are Antibiotic-Induced Suprainfections?

Antibiotic-induced superinfections are those infections that occur as a result of antimicrobial therapy. These are new infections that have evolved due to the misuse of antibiotic therapy. It simply means that when an individual is already taking antibiotics to treat a disease and because of taking these antibiotics, new infections emerge. These newly developed infections are termed suprainfections or superinfections.

What Are the Causes of Antibiotic-Induced Suprainfections?

Since antibiotics are antibacterial, they kill bacteria only. However, not all bacterias are pathogenic or harmful. The human body houses several bacteria that are nonpathogenic and not harmful. They help in various functions of the human body. They are termed good bacteria and contribute to the host's defense by producing bacteriocins that inhibit pathogenic organisms. Hence, the bacteria living naturally in the human body protect the human body from the attack of pathogenic or harmful bacteria.

However, antibiotics can alter the level of good bacteria (normal microflora) and can kill them too. When good bacteria are killed, the various functions they contribute also get disturbed. Importantly, when good bacteria are not present, the pathogenic bacteria grow. This is because if antibiotic therapy destroys all the good bacteria, then the pathogenic bacteria will have access to all the nutrients, and these pathogenic bacteria cause additional infections called suprainfections.

Broad-spectrum antibiotics usually lead to antibiotic-induced suprainfection. These are the type of antibiotic that covers both types of bacterias, gram-positive and gram-negative. Examples of these antibiotics are Tetracycline, Chloramphenicol, Azithromycin, Amoxicillin, Ofloxocin, Amoxicillin and clavulanic acid, and Quinolones.

Who Can Get Antibiotic-Induced Suprainfections?

The conditions which can make an individual prone to antibiotic-induced supra infections are discussed below.

• Individuals taking corticosteroids as these drugs are immunosuppressive and weaken an individual's immunity.

• Individuals with human immunodeficiency (HIV) or acquired immunodeficiency syndrome (AIDS) as their CD4 count (infection-fighting cells) is low.

• Individuals with diabetes, especially uncontrolled diabetes.

• Individuals undergoing anti-cancer medications.

• Individuals with an autoimmune disease like disseminated lupus erythematosus.

• Leukemia or other cancers will increase the risk of suprainfections.

Where Does Antibiotic-Induced Suprainfection Occurs?

These new infections occur at sites where normal microflora resides. For example, the intestine, skin, mouth, etc. The common sites for antibiotic-induced suprainfection are listed below.

• Intestine.

• Oropharynx.

• Respiratory tract.

• Skin.

• Genitourinary tract.

What Are the Examples of Antibiotic-Induced Suprainfections?

Examples of antibiotic-induced suprainfections are discussed below.

• Staphylococci, which become resistant, can cause infection in the stomach, such as enteritis (inflammation of the small intestine). These are treated with Cloxacillin, Vancomycin, or Linezolid.

• Clostridium difficile also becomes suprainfection. It produces an enterotoxin that damages gut mucosa forming plaques. Metronidazole and Vancomycin treat it.

• Proteus is also a bacteria that cause urinary tract infections and enteritis. It is treated by Gentamicin or Cephalosporin.

• Pseudomonas (aerobic bacteria) causes urinary tract infections and enteritis. It is treated by Carbenicillin, Piperacillin, Ceftazidime, Cefoperazone, or Gentamycin.

• Candida albicans is also an example. However, it is a fungus and causes diarrhea, thrush, and vulvovaginitis. It is treated by Nystatin or Clotrimazole.

To summarize, the bacteria most frequently linked to the emergence of superinfection are Candida spp., Enterococcus spp., enterobacteria, Staphylococcus spp., Pseudomonas aeruginosa, and Clostridium difficile. Ciprofloxacin is the most common antibiotic causing superinfections, followed by Cefotaxime, imipenem, Meropenem, and Cefepime. The usage of piperacillin-tazobactam is associated with the lowest percentage of superinfection.

How To Prevent Antibiotic-Induced Suprainfections?

The preventive measures to be taken to prevent antibiotic-induced suprainfection are discussed below.

• Use narrow-spectrum antibiotics and avoid broad-spectrum antibiotics. Antibiotics with a narrow spectrum only work against a specific subset of microorganisms. For example, Penicillin, Macrolides, and Vancomycin.

• Restrict the use of antibiotics on viral diseases or self-limiting diseases that can resolve independently after a few days, like the common cold.

• Do not prolong antibiotic therapy unnecessarily. The dose of antibiotics should be adequate. It should not be prolonged. Also, patients should be informed to take the full course of antibiotics. Generally, patients see improvement in the symptoms after one to two doses of antibiotics. And this is when most patients stop taking the full course prescribed by the physician. This could be harmful because the patient may then have to repeat the course of antibiotics if the infection re-emerges. Frequent antibiotic consumption is inadvisable owing to the high consequent possibility of developing antibiotic resistance.

Conclusion:

Antibiotic-induced suprainfections are difficult to treat as some of these infections could show antibiotic resistance. Therefore, preventing these infections is the preferred choice. Avoiding self-prescribing antibiotics can prevent not only antibiotic resistance but also antibiotic-induced suprainfections.