In the world of microorganisms, there are many different species of pathogens, which are intruders whose habitat is the human body. There are countless numbers of them! Some are necessary for us, but in most cases, they cause diseases. We are talking about bacteria, which are tiny microorganisms that inhabit our body. Some of them are our helpers – for example, the bacteria in our gut flora or those that live on our skin. However, many of them are unwanted guests that interfere with our health and even cause life-threatening infections. Thanks to science, we can deal with them. How does it work?

Today I am going to tell you about drugs that are used to treat bacterial infections, namely antibiotics.

They are considered the greatest invention of our time. Antibiotics, or antibacterial drugs, were invented by accident! The scientist Alexander Fleming, who was studying bacteria in 1928, forgot to close a dish containing bacteria that he was observing during his research. Spores of mold took advantage of the opportunity and crept onto the dish, and began to grow right next to the bacteria. What happened? In the area where the mold was growing, the bacteria began to disappear. The scientist concluded that the substance produced by the mold hindered the growth of bacteria – and he was right! This substance was named penicillin.

What are antibiotics?

Antibiotics are substances that are directed against bacteria.

• they hinder their growth, which means they can have a bacteriostatic effect or
• they have bactericidal properties, which means they kill bacteria.

But they only work on these pathogens, so antibiotics should only be used when a bacterial infection is suspected. Thanks to science, in addition to penicillin, we have discovered more and more new substances with similar effects. Each of them works a little differently, each has a different spectrum of activity, which means a group of bacteria that they can destroy.

The main problem with antibiotic therapy is that antibiotics used for bacterial infections will also affect all other, even beneficial, bacteria in our body, such as gut microflora. But the physiological role of flora is to:

• support the immune system
• ensure proper digestion
• produce vitamin K, which is produced by gut bacteria
• contribute to the proper functioning of the whole organism by producing various substances

Therefore, it is very important to remember that antibiotics should only be used for appropriate indications.

What are the forms of antibiotics used in children?

• Oral suspension – a ready-made product bought in a pharmacy in a bottle that is given orally to the child in the form of a thick syrup.
• Powder for suspension – a container of powder bought in a pharmacy that needs to be mixed with water and then given in the form of a suspension.
• Quicktab – tablets that dissolve in the oral cavity or in water.
• Tablets – to be swallowed, of course.
• Intravenous treatment (hospital treatment) –
• In the past, antibiotics were administered intramuscularly. Currently, in pediatrics in Poland, this method of administration is not recommended due to the too painful procedure and complications associated with this route of administration

If a child refuses to take a particular antibiotic due to taste, vomiting issues, or overall poor health, it is necessary to go to the hospital where the antibiotic will be administered intravenously.

Is there a difference between administering antibiotics intravenously or orally?

Yes, there is a difference. The gastrointestinal tract absorbs antibiotics to varying degrees depending on the chosen antibiotic. Some antibiotics are only partially absorbed.

It is also worth mentioning that the suspension antibiotic should be kept in the fridge.

Also, remember that some antibiotics such as amoxicillin, which is used in suspension, have a short shelf life after reconstitution. Always read the package insert to know the shelf life of the medication after reconstitution (for amoxicillin, it’s 7 days).

How does a doctor know: firstly when to prescribe an antibiotic, and secondly which antibiotic to choose?

It is a difficult and ambiguous question. They rely on subjective and objective examination. Based on the patient’s examination and reported symptoms, doctors try to use a detective-like method to determine which pathogen may be bothering the patient, which intruder is currently in the body.

For example, the most common pathogen that causes strep throat is the bacterium Streptococcus pyogenes, which is very common in our population. The same bacterium can cause strep throat, sore throat, and scarlet fever. Based on the examination, the doctors will suspect a bacterial infection because they see typical symptoms of strep throat. How do they choose the antibiotic? They then use empirical treatment, assuming that Streptococcus pyogenes usually responds to antibiotics such as phenoxymethylpenicillin. How do they know this? They learned this in microbiology, biochemistry, pharmacology, and many other parts of their medical training. They have to make decisions based on their knowledge. But there are situations when they are not entirely sure of their diagnosis, and they can use additional tests to support it. Staying with the symptoms of strep throat, if they do not have a full clinical picture, they can use :

• a rapid strep test. The result is obtained in about 15 minutes.
•  a bacteriological examination of a throat swab, we receive the result after a few days, which bacteria it is and which antibiotic it will respond to – in other words, we receive an antibiogram, a list of antibiotics that will cure streptococcus.

It is important because some bacteria become resistant, meaning they learn how to bypass antibiotics. This is the case with for example Staphylococcus aureus. It has evolved to be able to bypass simple penicillin, no longer responding to it, even though it once did. We are constantly observing a growing problem of antibiotic resistance among bacteria. New strains are emerging that do not respond to any antibiotics – the so-called superbacteria!

How to prevent antibiotic resistance – principles of antibiotic treatment.

1. The basic rule of using antibiotics is to use them on the explicit recommendation of a doctor, that is, when there is a suspicion that the infection is bacterial or there is a positive result of a bacteriological test. Of course, the recommendations for the use of antibiotics are described in various treatment standards, and sometimes you simply have to take that antibiotic. There is no doubt that there are many such situations.
2. Antibiotics cannot be discontinued too quickly. Although we may feel better after a few days of treatment, we must continue to take antibiotics for the prescribed period.
3. It is also important to take the medication at equal intervals in order to maintain a constant level of the drug in the blood. This is why some antibiotics are taken twice a day, every 12 hours, while others need to be taken every 8 hours.

What are the most common side effects of antibiotics?

1. I already mentioned one. Unfortunately, antibiotics affect all the bacteria in our body, including our intestinal flora. This most commonly causes diarrhea, vomiting, and nausea, which means the digestive system is disrupted. In such situations, we administer probiotics, which are good bacteria from the intestinal microflora. Probiotics should also be given after the end of treatment.
2. An unwanted effect of treatment can be allergic reactions. It is estimated that the problem may affect about 5 to 15% of people.
3. Sometimes blood changes can occure
4. A particularly severe complication of antibiotic use is a condition called pseudomembranous colitis.

In conclusion, antibiotics are the best weapon in the case of bacterial infections, but let’s use them wisely and only when absolutely necessary.

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