should we avoid them as we enter midlife?

“The take-home message from our study is not to stop or avoid taking antibiotics when needed. Antibiotics can be life-saving,” says Prof Adam Faye, assistant professor of medicine and population health at NYU Langone Health, and an expert in IBD.

However, some antibiotics are riskier than others.

“Our research suggests that a narrow-spectrum antibiotic – one that targets specific bacteria – may be associated with a lower risk of developing IBD. We saw that nitrofurantoin, an antibiotic commonly used to treat urinary tract infections, and which has minimal impact on the intestinal microbiome, did not appear to increase the risk of IBD.”

The class of antibiotics with the highest risk were nitroimidazoles, of which the most commonly prescribed is metronidazole.

Could probiotics make a difference?

“There is not enough evidence to show how they might help in people at risk of developing the disease or even for those who have already been diagnosed,” says Sarah Sleet, chief executive of the Crohn’s & Colitis UK charity. However, Dr Elisa Marroquín, assistant professor at Texas Christian University, last year co-authored a study showing that taking probiotics – which usually come in capsules – could prevent or lessen some antibiotic-induced changes to the gut microbiome.


Probiotics can also help protect species diversity and even restore the populations of some friendly bacteria such as Faecalibacterium prausnitzii, which reduces inflammation and promotes a healthy intestinal barrier.

Marroquin says: “Probiotics should be consumed alongside antibiotics to prevent or decrease side effects such as antibiotic-induced diarrhoea.” Taking them simultaneously, she says, “also seems to decrease the risk of developing antibiotic-resistant bacteria in our gut”.

Other experts recommend eating a specific diet to reduce the risk of IBD.

Professor Tim Spector, co-founder of Zoe, a nutrition app, and an expert on the microbiome is an advocate of fermented, colourful and fibre-rich foods that feed our gut bacteria, known as prebiotics.

“It’s a good idea to eat fermented foods daily and make sure we eat diverse plant fibres to support our gut microbiome during antibiotic treatment,” he says. Food for thought.

This article first appeared in the Telegraph, London

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