Antibiotics and CLL

[anapurna]

I've got signs of a chest infection and am on an antibiotic which sounds sensible. However antibiotics can weaken my already compromised immune system? Any thoughts?

[DriedSeaweed]

I suppose we do not have many alternatives... Ideally, would be great to not take antibiotics but the alternative of not clearing your chest infection could make you even more compromised.

[cajunjeff]

I think the bigger issue than antibiotics weakening our immune system is the resistance to antibiotics that we can develop if we are constantly getting infections and constantly resorting to antibiotics to fight them.

Its a catch 22 for which there is no great answer. My strategy is as follows.

First, and most obvious, I try not to get infections. While I don't live in a bubble and avoid people, I am more aware of my environment than before my diagnosis. I wash my hands more and totally avoid sick people. Its amazing the number of people who will tell you how bad their cold is, cough into their hands and then try to shake hands. I'll extend my elbow for an elbow bump, which folks are surprisingly happy to do.

When I feel like I am getting sick, I immediately try to figure out if its viral or bacterial. If its bacterial, I try to get on antibiotics immediately to fight the infection before it sets in.

That's the catch 22, if you get sick more, you need antibiotics more, which raise the risk of resistance more.

But what else are we going to do. Its a risk/benefit analysis. With our compromised immune system, we cant just hope bacterial infections run their course. Or at least I cant.

The good news for those of us like me on ibrutinib is that there is actually some evidence it helps restore our immune systems. I have been doing great the last six months, knock on wood.

[Cllcanada Top Poster CURE Hero in reply to cajunjeff]

We, the patient don't build up a resistance to antibiotics, the bacteria does...

cdc.gov/antibiotic-use/comm...

scientificamerican.com/arti...

There is some indication that some antibiotics like quinilones, a type of chemo actually, do effect he immune system in mice, in a negative way...

cell.com/cell-host-microbe/...

Ounce of protect is worth a pound of cure... has worked well for me... except for the fungus that flew in my open window...😁

We need to get antibiotics out of our food chain... before every bacteria becomes an antibiotic resistant super bug!

~chris 🇨🇦

[cajunjeff in reply to Cllcanada]

Yes the bacteria develop resistance. And generally speaking, we don’t think of antibiotics as weakening our immune system. This feels kind of nit picky. I’ll try to choose words more carefully. Sheesh.

[Cllcanada Top Poster CURE Hero in reply to cajunjeff]

Sorry didn't mean to nit pick... just a common misunderstanding.

[PaulaS Volunteer in reply to cajunjeff]

Chris wasn't being nit picky, Jeff. There's a BIG difference between the misunderstanding that we as individuals develop resistance to antibiotics if we use them a lot, and the reality that due to worldwide overuse of antibiotics, bacteria are evolving that are more resistant (regardless of who is taking them).

Some people are reluctant to take antibiotics as they are afraid that they personally will become “resistant” to them. They say they want to “save” the antibiotics for when they really need them.

This can be dangerous thinking, especially for folk with CLL. I'm sure none of us want to take antibiotics without good reason. But I don't think we'll be saving our immune systems by avoiding them. (Though there may be some particularly toxic antibiotics that are best avoided, such as Ciprofloxacin). As CLL folk, we really do need antibiotics much more than most people.

I will have to take daily antibiotics for the rest of my life, due to not having a spleen. My fear is not that I personally will get resistant to those antibiotics, but that increased use of antibiotics worldwide (which sadly I am adding to), will cause more bugs to evolve that can resist different antibiotics.

Annapurna, I hope you have a quick recovery from your chest infection,

Best wishes,

Paula

[Senecio]

Why would you think that antibiotics would weaken your immune system?

John

[Cllcanada Top Poster CURE Hero in reply to Senecio]

Some antibiotics may impact the immune system from... Harvard MIT..

wyss.harvard.edu/antibiotic...

[Senecio in reply to Cllcanada]

That research relates to a single antibiotic, ciprofloxacin which has two black box warnings associated with it. It has nothing to say about the many other antibiotics in common use.

As you know, antibiotics are a mixed bunch of chemicals, often derived from natural sources, which specifically target bacterial metabolism. Any effect on the immune system is coincidental, and probably doesn't happen in the majority of cases.

John

[AussieNeil Partner Administrator in reply to Senecio]

In a recent hospital stay for IV antibiotics to fight an infection, my neutrophils dropped considerably, from 2.3 to 0.9. My specialist said that a suppressed neutrophil count was occasionally an effect of IV antibiotics - it's one of their recognised side effects.

[Senecio in reply to AussieNeil]

It is true that there is a long list of things that are known to affect the immune system in a negative way. Off the top of my head:

Depression

Lack of vitamins, e.g. D, A, C

Lack of minerals, e.g. Zinc

Low environmental temperature,

Living in damp conditions,

Low light levels during the winter

Diseases (CLL springs to mind for some reason!) But common cold, influenza, pneumonia are probably more familiar to most people.

Chemotherapy drugs (quite a lot in there)

… but antibiotics? Really? They come quite a long way down the list.

I would like to see more of a balance here. For most of us (including the original poster I expect) antibiotics can mean the difference between life and death, and rejecting them because they *might* cause damage to the immune system would be foolish. I can think of a lot of more pressing reasons to worry about antibiotics, including sudden death in those who are allergic to them.

John

[AussieNeil Partner Administrator in reply to Senecio]

I fully agree with you. No one in our community should avoid antibiotics if they are prescribed. Doctors work on a least harm approach, so if antibiotics are prescribed, avoiding them is quite likely to put you at higher risk. I'm just pointing out that from personal experience, they can suppress your immune system.

Antibiotics have probably saved my life at least 3 times when I was admitted to hospital with serious infections. Obviously avoiding infections in the first place is far more preferable, but that's unfortunately not always possible.

[Senecio in reply to AussieNeil]

I didn't want to in any way belittle the issue which you experienced during your IV antibiotic treatment, sorry if that's how it came across. I've been reflecting on this whole issue over the last couple of days, and it sort of 'emerged' in my reply to your post!

Take care,

John

[AussieNeil Partner Administrator in reply to Senecio]

Hi John,

I appreciate where you are coming from, but I also want people to appreciate that CLL does reduce our buffer from the sometimes unavoidable consequences of having a serious infection - both as you point out from the infection itself and potentially from antibiotic treatment. It's something we need to keep in mind when approaching treatment (don't miss the treatment window or leave it too long), or even more so during treatment, when the treatment drugs can also hit our neutrophil production. Importantly it's not just chemotherapy drugs. Pretty well ALL CLL treatments have the potential to cause neutropenia, with Rituximab and Venetoclax renown for doing so - and they aren't chemotherapy drugs!

[HannahHugo]

My wife who has CLL (being treated with ibrutinib) and a compromised immune system has had many infections and elevated temperatures necessitating admissions to hospital. The first line of defence is always infused antibiotics prescribed by doctors there and her haematologist.

[very]

Antibiotics saved my husband from serious complication after developing a chest and urine infection. whats the alternative does not bear thinking about.

jenny uk

[umpireman]

Talk to your specialist about getting IVIG infusions. Along with antibiotics, they cleared up a sinus infection and chest congestion in a few weeks. John, the Umpire man