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Co-trimoxazole impairs colonization resistance in healthy volunteers
E J Vollaard1, H A Clasener, A J Janssen
1Department of Pharmacy, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
Abstract:
The influence of co-trimoxazole on colonization resistance of the bowel was investigated in six healthy volunteers, by measuring the numbers of indigenous aerobic flora and of a co-trimoxazole resistant challenge strain of Klebsiella pneumoniae. Impairment of colonization resistance of the bowel was shown by a significant increase in the numbers of yeasts in the faeces of five of six volunteers, by a significant increase in the numbers of Gram-negative bacilli in the faeces of two of six volunteers, and by facilitation of colonization of the bowel by the challenge strain in all volunteers. Impairment of colonization resistance of the mouth was shown by the development of glossitis caused by Candida albicans in two volunteers, and by a significant increase in the numbers of yeasts in mouth washings from four volunteers. It is concluded that co-trimoxazole impairs colonization resistance of the gastro-intestinal tract.
Insights
Co-trimoxazole significantly weakens the gastro-intestinal tract's natural defenses, allowing harmful microbes like yeasts and Gram-negative bacilli to overgrow. This antibiotic also facilitates the colonization of challenging bacteria, impacting gut health.
Area of Science:
- Microbiology
- Pharmacology
- Gastroenterology
Background:
- Colonization resistance is a crucial defense mechanism of the gastro-intestinal tract against microbial invasion.
- The impact of antibiotics like co-trimoxazole on this protective barrier is not fully understood.
Purpose of the Study:
- To investigate the effect of co-trimoxazole on the colonization resistance of the bowel and mouth.
- To assess changes in indigenous microflora and susceptibility to challenge strains following co-trimoxazole administration.
Main Methods:
- Six healthy volunteers were administered co-trimoxazole.
- Fecal and oral samples were analyzed for indigenous aerobic flora, yeasts, Gram-negative bacilli, and a co-trimoxazole-resistant Klebsiella pneumoniae challenge strain.
- Clinical signs of oral colonization resistance impairment, such as glossitis, were also monitored.
Main Results:
- Co-trimoxazole significantly increased yeast populations in the feces of 5 out of 6 volunteers.
- Gram-negative bacilli increased in the feces of 2 out of 6 volunteers.
- All volunteers showed facilitated colonization by the Klebsiella pneumoniae challenge strain.
- Oral colonization resistance was impaired, evidenced by Candida albicans-induced glossitis in 2 volunteers and increased yeasts in oral washings from 4 volunteers.
Conclusions:
- Co-trimoxazole demonstrably impairs the colonization resistance of the gastro-intestinal tract.
- This impairment affects both the bowel and oral mucosa, increasing susceptibility to microbial overgrowth and pathogen colonization.