I knew this as long ago as Y2K. I’d seen this effect in MANY MANY children as well as adults in people who had chronic sinusitis, asthma, allergies/eczema who, per history, had HAD many many ear infections or other infections treated with antibiotics very early in life.
This is a known issue. It is also, largely, an IGNORED issue.
To this day, the #1 issue seen in urgent care nationwide is URI (Upper Respiratory Infection) followed by Acute Bronchitis. BOTH entities are known to be caused predominantly by viruses and viruses alone. The rate of antibiotic prescribing at UCC’s nationwide for these conditions is, roughly, 70%. The number SHOULD be closer to ZERO (COPD, a few autoimmune disorders and some patients receiving certain MAB agents excluded, of course).
Someone getting an antibiotic for ANY reason is more likely to “require” treatment within a a year with another antibiotic for some other infection. Children given their first antibiotic before age 3 months have higher developmental disabilities, MOOD disorders, asthma, allergies, eczema, GI issues, autoimmune disorders, acne as adults and so on.
We NEED those bacteria to form hormone and neurotransmitter precursors.
But TRY, just TRY and convince doctors - and especially the freaking NURSE practitioners - NOT to prescribe an antibiotic for a URI and NOT to OVERPRESCRIBE (like 5 days of penicillin is as effective as TEN for acute streptococcal pharyngitis/tonsillitis and cephalexin is more effective at eradicating the carrier state) is the topic of at least one journal article, letter to the editor, or editor’s page opinion nearly every month in every journal.
Acute LOWER UTI (Urinary Tract Infection) treatment is three days, or if the patient can tolerate it, SINGLE dose. NOT TEN of something like Omnicef or Cipro although I’ve seen that done more times than I can count in my 30+ years as a practicing physician, fifteen in ER/Urgent care, even within the past several years by Nurse Practitioners.
The BUSINESS model drives this craziness. “If we don’t prescribe they’ll just go down the street to another UC and we’ll lose a customer.” Also something I’ve heard TNTC.
But patients DEMAND their antibiotics. Even come in same day they started their “emergency Z-pak” for a REFILL rather than calling the malpracticing physician who prescribed the damned thing and I tell them NFW!
My favorite story was an 18 year old mom of a 1 year old with a HEAD COLD and she asked, then demanded I write a prescription for an antibiotic. I gave her some symptoms to watch for, explained viral URI as best I could (to yet another public education victim) , some instruction on saline and suction (but he doesn’t LIKE it” she whined) and then she said “But what do I do when I decide he NEEDS an antibiotic?”
I paused, and said as uninflected as possible, “why, then you do four years of an undergraduate pre-med program, take the MCAT, go to four years of medical school, a year of a rotating internship and 3 to 4 years of a residency in a specialty of your choice and you can prescribe ANYthing you think he might need but in the meantime, since I have that kind of training, and I DON’T think he needs an antibiotic right now, I am not going to write a prescription for him.”
The owner of the company gave me a rash of shit over that and HE, from his DESK, called in a prescription for the kid sight unseen for a head cold of 24 hours duration. His malpractice, not mine.
My kids, 32 and 29, have the HEALTHIEST immune systems of anyone I’ve ever met and neither of them received antibiotics for any reason except ONCE and for less than a week, while growing up. They’ve both traveled the world extensively (north and southern hemisphere, tropics too), yes, they had the majority of the normal childhood immunizations skipping HPV but getting the one for meningitis before college as well as the mRNA covid spike protein shot which I begged them not to but they’re still healthy.
Yes, we NEED exposures. Trillions (yes, trillions) of virions (virus) and fragments of RNA/DNA/immunogenic proteins RAIN DOWN on us on any given day while we’re outdoors. It’s another reason “outdoorsy types” tend to be healthier along with a good dose of natural vitamin D and exercise. People joining new office practices (business, law, medicine) tend to get a lot more “colds” their first year in the group as they’re exposed to other viruses their immune systems may not have seen for a while and some they did but immune memory is NOT forever. We can and do (there are studies) get RSV, Coronavirus and many other viral infections repeatedly over time.
It’s a common misperception, a canard, that once infected, “natural immunity” lasts for a lifetime.
If only.
I was interested in doing a fellowship in infectious disease at one time, the Army, and life, had other plans but I still read a lot.
I was born in 1955, well before widespread vaccinations.
However, I was not nursed.
Bottle fed thanks to better living through chemistry.
My eczema started when I was less than a year old. Allergies showed up later.
I often wonder how things may have been different if I had been nursed but again, there’s no going back in time and redoing everything to find out. So now I’m dealing with the results of that. It seems that it never gets better.
Thank you for an excellent post.
I wish more doctors had your wisdom.