Antiobiotics make whooping cough worse.

[Momtezuma Tuatara]

I am tranferring the information I put on Mothering https://www.mothering.com/discussions/showthread.php?t=332284 to here:

Does this tell you semething? As in perhaps you shouldn't use antibiotics in pertussis?

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14595048&query_hl=7



Children who received an antibiotic had a duration of cough 6 to 11 days longer and spasmodic cough 4 to 13 days longer than untreated patients.

It has been reported that erythromycin reduces the severity and duration of disease when started early.8 We used a stringent definition of antibiotic treatment and a duration of treatment of 7 days based on the observation that this course of therapy is comparable to 14 days.18 Although this study was not designed specifically for estimating antibiotic clinical efficacy, antibiotic treatment was found to be a marker of severe disease, a finding that is similar to the results of previous studies.10 Despite recommendations that treatment be started early for improving the clinical course of the disease, most trials on the efficacy of antibiotics in patients with pertussis have focused on the eradication of B pertussis rather than on the duration of symptoms.19 This issue probably deserves more attention in future studies.


Do you reckon that's a euphemism for " Oh no, antibiotics don'g work..."

and

"Lets make some more money studying it" ????

[Momtezuma Tuatara]

so you go to the full article here http://pediatrics.aappublications.org/cgi/content/full/112/5/1069

and this is what you find:


Besides the typical symptoms, complications and hospitalizations were rare in our cohort. Although this finding probably reflects the selection of patients for participation in the trial, a study conducted in the United Kingdom also suggests that the disease is much less severe than suggested by textbook descriptions or parents’ fears.

That study was a very interesting one, and can be read here: http://bmj.bmjjournals.com/cgi/content/full/310/6975/299 Hmmm. I think you have to have a subscription. I will make a pdf of the one I have and put it on this thread.

[Momtezuma Tuatara]

So let's look at the Tozzi study above... attached below

At the results and (contradictory conclusions)



RESULTS: The analysis was conducted on 788 laboratory-confirmed cases of pertussis. The median duration of cough in DT recipients varied from 52 to 61 days across the 3 stages, whereas the median duration of cough in DTaP recipients varied from 29 to 39 days. The median duration of spasmodic cough varied from 20 to 45 days in DT recipients and from 14 to 29 days in DTaP recipients. The results of the analysis of variance models showed that vaccination against pertussis reduced the length of cough from 3 to 10 days and the length of spasmodic cough from 4 to 8 days.


Is that much of a difference?



Conclusions. Duration of cough can be greatly influenced by vaccination status ....(yet).......The proportion of cases observed from July to September, the period in which maximum incidence usually occurs, varied from 28.7% among the DT recipients to 33.8% among the DTaP SB recipients, with no significant differences (P = .714).


ahem?

So now we look at hospitalizations:



During the whole study period, the hospitalization rate, which also includes visits to the emergency department, was 1.8%. A total of 11 hospitalizations and 3 emergency department visits were reported: 3 hospitalizations and 2 emergency department visits among the DT recipients, 4 hospitalizations and 1 emergency department visit among the DTaP SB recipients, and 4 hospitalizations among the DTaP CB recipients. The length of hospitalization ranged from 2 to 10 days. Of the 14 hospitalizations and visits, 8 were reported for children <36 months of age. There was no difference in the number of hospitalizations and visits by vaccine group.


No, you would think this had been worked out long ago, because we've always been told that if you're vaccination your symptoms are less, right?



Although previous works have reported on the clinical characteristics of pertussis at various ages, little research has compared the symptoms in vaccinated children with those in unvaccinated children.


So the house of cards is a bit shakey, right?

[Momtezuma Tuatara]

Then we got talking about why antibiotics make pertussis worse:

I said[quote]We know that antibiotics taken during pregnancy, makes a child more susceptible to asthma. That's published in the medical literature.

We know that tooth decay is related to immune function. That is why someone with tetanus can suddenly get large cavities. WE know that kids who take antibiotics when a tooth is forming will end up with crumbly molars that just disintegrate.

There is so much that we know that antibiotics CAN do, but we cannot answer the questions as to why to everything.

But here's my theory, though to understand it you'll have to understand endotoxin in a broader way than perhaps you do now.

Firstly, the human gut is filled with probiotics "whose" primary job is to keep a bacterial balance. Every baby has some gram negative bacteria, but bottle fed babies have 1,000 times more than breastfed, but even breastfed babies can have them if they have a low grade fever, and the mother is silly enough to give comp bottles, which result in a bacterial rating the same as completely formula fed babies.

Erthromycin is the greatest gut stripper out that there is, good, bad and otherwise. It creates hell and back again with me, and many kids who have had whooping cough even quite mildly, and been put on erythromycin have gone backwards fast.

The only way to help them out of it is to replace the probiotics and then whack in even more vitamin C and here's why.

They key to understanding why pertussis babies get worse on antibiotics is to understand gut flora. When the good gut flora is destroyed, it makes space for gram negative bacteria. The foremost gram negative bacteria in the gut E.coli, but its not the only one. We all have e.coli. It's a commensal, and in small amounts performs some useful functions. But that's where the good story ends. FIRST up, the erythromycin kills the gram negative bacteria in the gut as well as the good gut flora.

Oh yum. Trouble coming http://www.mothering.com/discussions/images/smilies/bigeyes.gif

The part of e.coli, and other gram negative bacteria that is endotoxin is the envelope. When the bacteria multiple normally, just a little bit drops off (imaging a hippo with extra skin taking a tuck...) and that is called "curlin". But when antibiotics kill e.coli, huge amounts of dead skin break up and become huge amounts of endotoxin, and has to be processed through the liver kuppfer cells. But when you use antibiotics which happen to kill gram negative bacteria, and the body gets a huge bolus dose of curlin, that puts the liver under huge pressure, and it slows down so much that curlin gets through into the bloodstream, becasue the liver can only cope with so much.

The child may also be carry gram negative strep in the throat and elsewhere, and if that is killed it too released its own endotoxin into the blood stream, but the quantities are nowhere near that which will be released by the gut. E.coli is usually the source of the majority of secondary endotoxin about to flood the liver.

The child will have some endocab (endotoxin core antibodies) in the blood, and so long as there are enough endocab to neutralise the curlin, relatively fine though there will be worsening symptoms while the body struggles to contain the mess. But if/when endocab runs out, things go even further backwards, and you're looking at apneoa and seizures.

The only other thing that neutralises curlin other than endocab is vitamin C, so if the baby is a sensible Mothering baby, whose mother knows to dose bigtime, then that will be no problem for the baby. The baby will be so full it will be okay BUT>>>>> after antibiotics a Mothering mother will need to radically increase vitamin C. But hopefully a Mothering mother won't be using antibiotics, will she??? http://www.mothering.com/discussions/images/smilies/hammer.gif

But these babies are babies of parents who think the sun shines outta the local pharmaceutical pushers and shovers incorporated, who will not, of course, know a thing about vitamin C.

So that poor baby is now struggling with endotoxin from the gut, not being trapped by the liver, leaking through and using up endocab and vitamin C in the blood, which up until then have PRIMARILY been used to neutralise the endotoxin from the pertussis bacteria coming from the bronchials.

We know that erythromycin doesn't touch the pertussis bacteria in the bronchials anyway, which is adhered to the cilia in the bronchials, so why blimmin well use it http://www.mothering.com/discussions/images/smilies/angry.gif. These pertussis bacteria are still putting out pertussis toxin into the mucus, which is still absorbed into the body, and the blood stream, which was previously neutralised by endocab, which is now trying to neutraliseting all the endotoxin released from the gut by the antibiotics.

Course, doctors haven't worked these things out for themselves, because they don't know how to figure these things out. Basic common sense and an understanding of well documented physiology. I have medical literature on this from Tissier in 1903!!! It's not like it hasn't been extensively studied, but see, its old, and anything not in the last five years, is stone aged medicine, right? Just like vitamin C is just a vitamin right? If the pharmaceutical companies don't tell doctors what to do, what would they know unless they fell over it themselves, or were hit over the head by realists?

Now you know why, for years, and years, and years, here, in my various incarnations I have PLEADED, shouted, ranted and raved and begged on bended knees for mothers to NEVER us antibiotics with pertussis.

Antibiotics do no good in pertussis, and can do harm in a baby whose diet is short of vitamin C. And of course, when these babies who are put on antibiotics with not enough vitamin C and running out of endocab, suddenly get worse and die, the doctors then say to the mothers "We did everything we could your baby died of whooping cough! (should have had them vaccinated silly !nevu mind the vaccine doesn't work...)".

Yet, the death certificate should read "this baby died because the doctor was ignorant about vitamin C, and also about how antibiotics can provoke endotoxemia from the gut and overwhelm the kuppfer cells and serum endocab.

CallmeIshmael gets that bit wrong. Antibiotic administration is never an indication of severity. It's always an indication of parental or paediatrician's distress, and I've seen babies go from antibiotics, to the oxygen tent to life support, not because the pertussis is super severe, but because babies suddenly have to deal with endotoxin from two sources, not one. But of course, because doctors don't KNOW how to "see" endotoxemia in totality, they will assume that its an increase in severity in the pertussis endotoxemia.

But... if they knew something about vitamin C, then none of any of that would have happened, babies wouldn't get so seriously ill that anyone would even think about antibiotics.

In my 24 years of being emotional nanny to mothers with pertussis babies, I've turned around so many so-called serious cases and converted them into averagely ill, and some of you here, know that, because you've learned how to do that at this board.

But doctors do not understand the basic concepts of endotoxic shock in its entirety, and don't realise what they are doing when they prescribe antibiotics and can't see that the antibiotics are creating a second source of endotoxic shock from the gut, which causes double trouble, and puts double strain on endocab ( endoab - endotoxin core antibody).

They have not learned, and for some pathological reason cannot learn to think.

If a kid makes it through that first bolus dose of endotoxemia from the gut from the first dose of the first antibiotic course, and afterwards doesn't get probiotics re-established in the gut ~~~~ and you tell me one doctor who prescribes probiotics http://www.mothering.com/discussions/images/smilies/duh.gif http://www.mothering.com/discussions/images/smilies/headscratch.gif https://www.mothering.com/discussions/images/smilies/hopmad.gif, then the gram negative bacteria, which are the ones that recolonise fastest, continue to provide longer term low-grade endotoxemia afterwards, which of course, hampers recovery because again, the body is having to detoxify from two sources not one. And if the doc decides on a second course, you can go through the same jolly cycle again http://www.mothering.com/discussions/images/smilies/angry.gif.

[Momtezuma Tuatara]

I'll also pdf this one:

Clinical Infectious Diseases 1992;14:708-719 "Epidemiological Features of Pertussis in the United States, 1980 - 1989" Farizo K M. et al.

On page 714 under the table it said:



"when treatment with erythromycin was initiated... the duration of cough tended to be even longer than for persons who did not receive erythromycin at all."

Well now, isn't that amazing.

So they've been prescribing antibiotics for pertussis all those years on the basis of garbage science, not realising that it actually makes the outcome for the patient potentially worse?

[Momtezuma Tuatara]

Returning to the pediatrics article here http://pediatrics.aappublications.org/cgi/content/full/112/5/1069

if we go to table 1 it breaks down the total number of cases of pertussis by group. There is no difference b/w the three groups. But in the methods section there were three times as many kids in every DTaP group than in the DT group. Becuase the cases were the same numbers i.e. three times the cases in DT group as in DPT grounp, that is interpretted as vaccine efficacy here in this study published by the same authors. http://content.nejm.org/cgi/content/abstract/334/6/341

However, as Cherry said the year before:

http://www.ncbi.nlm.nih.gov/pubmed/9755264


CONCLUSIONS: Our data suggest that observer compliance (observer bias), can significantly inflate calculated vaccine efficacy. It is likely that all recently completed efficacy trials have been effected by this type of observer bias and all vaccines have considerably less efficacy against mild disease than published data suggest.

To me, observer bias is consistent with the actual results above: that the vaccine makes no difference to actual outcomes, and that the claimed efficacy in the trials is a result of the researchers assuming that vaccinated children had something else, and assuming that unvaccinated children had pertussis and NOT looking for anything else.

Reminder to self to pdf the Cherry article, and attach here.

[Momtezuma Tuatara]

Here is the 2005 cochrane review of antibiotic use in pertussis:

http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004404/frame.html

ubmed:
AUTHORS' CONCLUSIONS: Antibiotics are effective in eliminating B. pertussis from patients with the disease, rendering them non-infectious, but do not alter the subsequent clinical course of the illness......

cochrane site:
We found that several antibiotic treatments were equally effective in eliminating the bacteria infecting patients, but they did not alter the clinical outcome. There was insufficient evidence to decide whether there is benefit for treating healthy contacts.

Full pdf attached for the incredulous, and so that I can't be accused of selective quoting. :giggle: . Stick that under your doctor's nose if he tells you that antibiotics will fix your child's whooping cough.

[Momtezuma Tuatara]

In 2007 they did an update, which essentially found the same thing:

Pubmed:
AUTHORS' CONCLUSIONS: Although antibiotics were effective in eliminating B. pertussis, they did not alter the subsequent clinical course of the illness. There is insufficient evidence to determine the benefit of prophylactic treatment of pertussis contacts.

cochrane site:http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004404/frame.html


Contact prophylaxis of contacts older than six months of age with antibiotics did not significantly improve clinical symptoms or the number of cases developing culture-positive B. pertussis. In other words, antibiotics given to people older than six months, didn't prevent them getting it....

Which makes me wonder how it can then prevent them from spreading it, after the antibiotics didn't stop them from getting it. Weird... then:


Authors' conclusions
Although antibiotics were effective in eliminating B. pertussis, they did not alter the subsequent clinical course of the illness. There is insufficient evidence to determine the benefit of prophylactic treatment of pertussis contacts.

full cochrane review attached, so that I can't be accused of selective quoting. :giggle:

[Momtezuma Tuatara]

the fact that Erythromycin doesn't cure pertussis, or make the patient better, has been known since 1977;

Infection. (javascript:AL_get(this, 'jour', 'Infection.');) 1978;6(5):228-30. PMID: 215555 [PubMed - indexed for MEDLINE]


http://www.springerlink.com/content/h370t226u5723236/



Summary The effectiveness of oral erythromycin and amoxycillin in eradicatingBordetella pertussis from the nasopharynx was compared. Erythromycin in a dosage of 40–50 mg/kg/day was significantly more effective than amoxycillin in a dosage of 25–30 mg/kg/day. The organism did not disappear in three cases receiving a lower dosage of erythromycin. As antibiotic treatment does not affect the clinical course of fully-developed whooping cough, erythromycin is indicated primarily when particularly susceptible individuals are threatened by exposure.In such cases erythromycin should be given as soon as whooping cough is suspected. but it was the 2007 cochrane review which found no effectiveness in preventing pertussis in people who had contact with a case.

Why do doctors persist in telling parents it will work, and giving it to contact? Is it to maintain the myth that, "We can fix everything..."?

I've attached the free preview, because it contains another piece of nonsense: that antibiotics prevent pertussis from developing in the catarrhal stage. This is more than nonsense.

For a start, no-one suspects whooping cough in the cattarhal stage. It could be just a cold. So where are the large scale studies of that? There aren't any. It was just a supposition. And if antibiotics prevented whooping cough from developing in the catarrhal stage, why don't they prevent it from developing when given prophylactically before the cararrhal stage?

[Momtezuma Tuatara]

another interesting 2006 study... do they believe their own dogma?:

http://www.journals.uchicago.edu/doi/full/10.1086/500420?cookieSet=1



It is of interest that no cases were found among the hematology‐oncology unit patients. It is hypothesized that routine careful attention to handwashing and the routine use of protective masks by employees with upper respiratory infections entering patient rooms were protective for the patients. Antibiotic use for other purposes in these patients may have provided protection, but only 13 of 44 patients were treated with antibiotics with known or purported activity against B. pertussis. 16 (http://www.journals.uchicago.edu/doi/full/10.1086/500420?cookieSet=1#rf16) It was hypothesized that positive air‐pressure rooms provided an additional protective effects, but this could not be assessed. Although employees routinely washed their hands and used masks within patient rooms, they did not use masks within the nurses’ station, leading to transmission during contact within the unit.

This is full text, so you can read it there...

[Piotr]

I wonder why Cochrane 2007 did not include the Tozzi 2003 paper? They measured the impact of antibiotics vs. no antibiotics. Instead they found and included only one paper where antibiotics were not used in the control group:

"It is noticeable that there was only one study included in the treatment regimen that compared antibiotics with no treatment (Bass 1969). Hoppe 1992 reported that in Germany it would be considered unethical by most physicians to withhold appropriate antimicrobial treatment from a child with proven or strongly suspected pertussis. This view might also be applicable in many other parts of the world. However, from a purely scientific perspective the lack of such knowledge makes it hard to know the true effect of antibiotic therapy."

Bass 1969 measured also that antibiotics are effective in elimination of bacteria (Microbiological eradication). But "The clinical course of illness in the study by Bass (Bass 1969) was
presented per individual patients and it was not possible to analyse these data accurately, however, the author reported that there was no significant difference in the subsequent course of illness
in those groups receiving antimicrobial therapy when compared with the untreated control group."

very interesting...

[Fièvre]

Piotr,
Would you give the references for the Tozzi 2003 paper ? thank you .

[Piotr]

sorry it was late and I forgot about that Tozzi 2003 (http://pediatrics.aappublications.org/content/112/5/1069.long), I think it is uploaded here already.

[Fièvre]

Thank you Piotr !
I picked up this :

Antibiotic treatment is believed to be effective in improving the course of the disease if started early,8 (http://pediatrics.aappublications.org/content/112/5/1069.long#ref-8) although some studies have found that treatment has no effect.9 (http://pediatrics.aappublications.org/content/112/5/1069.long#ref-9),10 (http://pediatrics.aappublications.org/content/112/5/1069.long#ref-10) Nonetheless, the disease is often recognized late, and appropriate antibiotic treatment is consequently begun too late to be effective or to prevent secondary cases.
Despite recommendations that treatment be started early for improving the clinical course of the disease, most trials on the efficacy of antibiotics in patients with pertussis have focused on the eradication of B pertussis rather than on the duration of symptoms.19 (http://pediatrics.aappublications.org/content/112/5/1069.long#ref-19) This issue probably deserves more attention in future studies. You will have noticed :

Besides the typical symptoms, complications and hospitalizations were rare in our cohort. Although this finding probably reflects the selection of patients for participation in the trial, a study conducted in the United Kingdom also suggests that the disease is much less severe than suggested by textbook descriptions or parents’ fears.8 (http://pediatrics.aappublications.org/content/112/5/1069.long#ref-8)

As for Cochrane is your ref this one : http://www.ncbi.nlm.nih.gov/pubmed/17636756 ?

[Piotr]

Yes it is the one. I will be more precise in the future.

I see it like this:
- there is no data to state that antibiotics used at early stage are better as compared against no-treatment control group (all the studies with no treatment group state that the antibiotics were used at a later stage)
- there is data that antibiotics started late prolong the illness as compared against no-treatment control group (Tozzi 2003)
- there is another remark in Tozzi 2003 but reference 9 is not available and reference 10 is just abstrakt in pubmed "Antibiotic treatment is believed to be effective in improving the course of the disease if started early,8 (http://pediatrics.aappublications.org/content/112/5/1069.long#ref-8) although some studies have found that treatment has no effect.9 (http://pediatrics.aappublications.org/content/112/5/1069.long#ref-9),10 (http://pediatrics.aappublications.org/content/112/5/1069.long#ref-10)
reference 10 = http://www.ncbi.nlm.nih.gov/pubmed/6886900

taking this all together
- antibiotics (even used at later stage) were found to eliminate the B. pertussis from the nasopharynx (Cochrane - http://www.ncbi.nlm.nih.gov/pubmed/17636756) but prolong the illness (Tozzi - http://pediatrics.aappublications.org/content/112/5/1069.long). Maybe the antibiotics were used only for children with more severe WC which resulted in the this negative outcome as stated in Tozzi 2003 "Although this study was not designed specifically for estimating antibiotic clinical efficacy, antibiotic treatment was found to be a marker of severe disease, a finding that is similar to the results of previous studies.10 (http://pediatrics.aappublications.org/content/112/5/1069.long#ref-10)"

- It seems to me that elimination of bacteria from the nasopharynx is definitely not the key to shorten the symptoms of WC.


Just to clarify, I am not in favor of antibiotics, just looking critically at the available data.

[Fièvre]

Piotr,
You said
Just to clarify, I am not in favor of antibiotics, just looking critically at the available data. I had undestood .
You wrote
Maybe the antibiotics were used only for children with more severe WC which resulted in the this negative outcome as stated in Tozzi 2003 "Although this study was not designed specifically for estimating antibiotic clinical efficacy, antibiotic treatment was found to be a marker of severe disease, a finding that is similar to the results of previous studies.Indeed the status of these treated children is not clear .


NB : SORRY : I just realized this is page 2 ( I first thought the thread had begun on this very page . Much had been already discussed !!! sorry again )

[Piotr]

Thanks Fievre! I had to re-read the first page too.



Course, doctors haven't worked these things out for themselves, because they don't know how to figure these things out. Basic common sense and an understanding of well documented physiology. I have medical literature on this from Tissier in 1903!!! It's not like it hasn't been extensively studied, but see, its old, and anything not in the last five years, is stone aged medicine, right?

I was able to find (with my very limited research skills) some studies providing evidence that Vit C helps against endotexemia. Just two examples:

Mol Cell Biochem. (http://www.ncbi.nlm.nih.gov/pubmed/9350041) 1997 Oct;175(1-2):117-23. Impaired phosphatidylcholine biosynthesis and ascorbic acid depletion in lung during lipopolysaccharide-induced endotoxaemia in guinea pigs.
http://www.ncbi.nlm.nih.gov/pubmed/9350041

“Guinea pigs fed on a diet with a low content in ascorbic acid were more sensitive to endotoxin. In these animals we found no detectable levels of ascorbic acid in lung, whereas both vitamin E lung levels and pulmonary phosphatidylcholine synthesis were significantly decreased. Our results point out the significance of ascorbic acid in the protection against oxidative lung injury associated to endotoxaemia, and validate our shock model for further studies on the mechanisms of this pathological condition.”


Circulation. (http://www.ncbi.nlm.nih.gov/pubmed/12234948) 2002 Sep 17;106(12):1460-4. High doses of vitamin C reverse Escherichia coli endotoxin-induced hyporeactivity to acetylcholine in the human forearm.
http://www.ncbi.nlm.nih.gov/pubmed/12234948

"LPS administration caused systemic vasodilation, increased white blood count, elevated body temperature, and reduced vitamin C plasma concentrations. LPS decreased the responses of forearm blood flow to ACh by 30% (P<0.05) but not to GTN. Vitamin C completely restored the response to ACh, which was comparable with that observed under baseline conditions. Vitamin C had no effect on basal blood flow or ACh- or GTN-induced vasodilation in control subjects.

CONCLUSIONS: Our data demonstrate that impaired endothelial vasodilation caused by E coli endotoxemia can be counteracted by high doses of antioxidants in vivo. Oxidative stress may play an important role in the pathogenesis of endothelial dysfunction during inflammation."

I am sure there must be more and the role of Vit C and the endotoxemia. Not from the so-called stone age. Am I right or wrong?

[Momtezuma Tuatara]

You are right. There is a European consensus document - I will post it some time when I'm not too frazzled.

[Piotr]

I will be very grateful. On my new portal about pertussis I am going to add info about antibiotics, altitude treatment, and summarized version of your "theory" from page 1 about the endotoxemia in the gut following antibiotic treatment (here nice evidence for it Schulze 2000 (http://www.springerlink.com/content/a6fwpun4f564dhuh/)) and vit C usage. Because I don't feel comfortable with giving people advice on the treatment I use the phrase "as stated in the medical literature....". That is why I asked about the literature on Vit C and endotoxemia.

[Momtezuma Tuatara]

Here is the consensus document.

But because it's been long known, I've added others as well.