Antibiotics and Athletes

• While antibiotics are a modern medicine marvel, they are heavily overprescribed.

• Consider what you may have: a virus or bacteria? This determines your need for them.

• Limiting your exposure to antibiotics can be helpful in ensuring you can get back to training and competing quickly.

• I recommend taking a high-quality probiotic during and after a course of antibiotics.

• When healthy and rested, your body’s immune system can deal with many insults.

This article was written by Dr. Kevin Sprouse. Dr. Sprouse is a team physician for the EF Education – Easy Post Pro Cycling Team. He has a degree in exercise science and has board certifications in both Sports Medicine and Emergency Medicine. He practices at Podium Sports Medicine in Knoxville, TN.

This time of year, a large portion of our population ends up on antibiotics. For those of us that are athletes or inclined to maintain a high level of activity, that can be detrimental. Indeed, antibiotics can cause as many problems as they can cure.

Now, to be clear, antibiotics are one of the marvels that have come from modern medicine and science. They have provided a massive benefit to humankind, and millions of lives have been saved by these amazing compounds. When necessary, antibiotics are truly miracle medicines. All too often though, antibiotics are prescribed when they are not warranted. Even when they are warranted, they can have side effects which impact fitness and performance. So what is an athlete to do?

First and foremost, your health is paramount to your athletic fitness. Continued illness is not conducive to maximum performance. When necessary, antibiotics certainly should be used, but there are some things you can do to limit the deleterious side effects.

In the US, medical practitioners are notorious for prescribing antibiotics when there is clearly no indication to do so. Head colds and bronchitis are almost uniformly caused by viruses. Viruses are not the same as bacteria. Antibiotics treat bacteria, but they do nothing for viruses. As I once overheard a veteran pro cyclist tell a young rider, “Your cold will last about seven days, but if you take antibiotics, you’ll be over it in a week.”

In addition to those conditions for which antibiotics are useless, there are other illnesses which are bacterial but self-limiting. Said another way, your body is strong enough to deal with them on its own. Of course, this is a determination that should be made only by a physician, but certain ear infections, sore throats, skin infections, and the like can be treated by time and a healthy immune system. Ultimately, our society significantly overuses antibiotics. You should discuss your illness with your doctor to determine if there is truly a reason to use these drugs.

When there is need for these amazing medicines, science suggests that there are some things you can do to mitigate the potential side effects. Here are a few things to consider.

Shorter courses of medications.

Many simple infections (sinus, urinary, etc) can be treated with as few as three days of medicine, especially in otherwise healthy patients. Limiting your exposure to antibiotics can be helpful in ensuring you can get back to training and competing quickly. Of course, some infections require much longer duration of treatment. This is a determination that should only be made by your physician, and you should never cut short a course of treatment without discussing it with your prescribing doctor.

Appropriate antibiotic choice.

It is up to your doctor to choose a medicine which is appropriate for treating your illness, but let them know that you are an athlete and enjoy a healthy lifestyle of vigorous activity. Some medicines have musculoskeletal side effects that make them poor choices for athletes. Personally, I try not to prescribe any fluoroquinolones (“Cipro”, Levaquin, etc) to athletes I treat, due to a well-documented side effect of tendon problems. Sometimes fluoroquinolones are needed, but your athletic lifestyle should certainly be a consideration when selecting appropriate medications.

Probiotics

We are continually learning more about the importance of a healthy gut. The good bacteria that live in our intestines are crucial to our overall health and even to our athletic performance. Antibiotics can disrupt the balance of bacteria in your gut, even wiping out colonies of the good ones. I recommend taking a high-quality probiotic during and after a course of antibiotics. Your doctor can help you choose a product and tell you how to dose it. Try out Sound Probiotics!

N-acetylcysteine (NAC)

Inside each of your body’s cells are small energy factories called mitochondria. These mitochondria are essential to life and to optimal physiologic function. Dysfunctional mitochondria can lead to numerous problems including fatigue and poor athletic performance. It is theorized that these little energy factories originated from bacterial coexistence with human cells somewhere along our evolutionary pathway.

Because of this basis in bacteria, it was further theorized that antibiotics might adversely impact the function of mitochondria. (It’s a common complaint of elite athletes that their fitness and aerobic capacity is significantly limited while on antibiotics.) Some early research is starting to suggest that this may be true. A paper published by a group at the National Institutes of Health in 2013 showed this to be the case in mice.

The good news is that these ill effects were alleviated with the use of N-acetylcysteine (or “NAC”). NAC is an antioxidant supplement which also serves as a precursor of glutathione. In addition to this potentially protective effect, NAC is often recommended as a dietary supplement for athletes in other circumstances. When used correctly, NAC can be a very beneficial supplement and can possibly protect against some side effects of antibiotics. It’s a win, win!

Rest while being treated.

This is such a basic but often overlooked part of treatment. When healthy and rested, your body’s immune system can deal with many insults. Athletes tend to train and compete even when sick. That’s often a very bad decision! Not only will you delay healing, you may make things much worse. If you’re sick, rest. If you are so sick that you require antibiotic medication, rest a lot!

Antibiotics are great medications! They get unfairly vilified in a society that has an obsession with wellness but an ignorance of the scientific evidence. Antibiotics are not bad, but the prescribing practices of many practitioners are admittedly horrendous. Likewise, many patients demand antibiotics for illnesses that do not warrant them. In the end, they are a powerful treatment which should be used appropriately. And when used, there are certain precautions that active individuals should take in order to minimize the impact on their health and performance.