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Campaigning for antibiotic conservation is a bit like the struggle against global warming. The polar ice melts while politicians, not known for long-range thinking, debate deadlines for others to meet. Similarly, new drug discovery diminishes as resistance to existing antibiotics increases. Public health officials and policy makers predict a bleak future and plead for reform of prescribing practices, but clinicians deal with individual patients, not populations, in the present. Perhaps, it is time to direct the educational narrative on antibiotics towards the consumer. Enthusiasm for antibiotic treatment, particularly for soft indications, might be tempered if the potential adverse effects on the microbiota were better known. Antibiotic-associated diarrhoea and Clostridium difficile-associated disease are well recognised but more subtle effects are less well appreciated. Few clinicians may know that antibiotics can induce an immune deficiency in experimental animals. Furthermore, increasing evidence suggests that disturbance of the indigenous microbiota by antibiotic exposure, particularly in early life, is a risk factor for later development of obesity-related metabolic disorders and several immunologically mediated disorders, such as IBD and asthma.1– ,3 Concern about the adverse effects of antibiotic exposure will escalate with better understanding of host–microbe interactions in host development and homeostasis, especially when …
Funding The author's work has been supported in part by grants from Science Foundation Ireland in the form of a centre grant (Alimentary Pharmabiotic Centre; Grant Numbers SFI/12/RC/2273 and 12/RC/2273).
Competing interests The author is a shareholder in a university campus company Alimentary Health and directs a research centre which holds collaborative grants with Janssen pharmaceutical, Trino Therapeutics, General Mills, the Kerry Group, Mead Johnson Nutrition, Friesland, Cremo, Sigmoid Pharma, Second Genome and Nutricia.
Provenance and peer review Commissioned; internally peer reviewed.