Antibiotic exposure and risk of Parkinson's disease in finland: A nationwide case-control study.

[aspergerian13]

Antibiotic exposure and risk of Parkinson's disease in finland: A nationwide case-control study.

ncbi.nlm.nih.gov/m/pubmed/3...

METHODS: We identified all patients who were diagnosed with PD in Finland during the years 1998 to 2014. Information was obtained on individual purchases of orally administered antibiotics during the years 1993 to 2014. We assessed the association between prior antibiotic exposure and PD using conditional logistic regression.

RESULTS: The study population consisted of 13,976 PD cases and 40,697 controls. The strongest connection with PD risk was found for oral exposure to macrolides and lincosamides (adjusted odds ratio up to 1.416; 95% confidence interval, 1.053-1.904).

After correction for multiple comparisons, exposure to antianaerobics and tetracyclines 10 to 15 years before the index date, sulfonamides and trimethoprim 1 to 5 years before the index date, and antifungal medications 1 to 5 years before the index date were positively associated with PD risk. In post hoc analyses, further positive associations were found for broad-spectrum antibiotics.

[WinnieThePoo]

For what little its worth, I was suspicious that antibiotics and their impact on my intestinal and nasal microbiomes, may have had a role in "unmasking" at the very least. My PD onset suddenly after an ear infection leading to Eustachian tube defect, and involving 2 courses of oral antibiotics, and a nasal nebuliser regime

[aspergerian13 in reply to WinnieThePoo]

WtP,

An important anecdote, plus the nuance: unmasking.

[park_bear]

Firstly, thanks for posting the text.

Important to remember that association does not prove causation. What all these patients had in common was infection. There are a number of people with Lyme disease who have been subsequently diagnosed with Parkinson's. Maybe this is coincidence but I think not. So infection may be the culprit. Another possible link is the effect of antibiotics upon the bacterial biome in the gut. So, interesting data needing further research for a deeper understanding.

[aspergerian13 in reply to park_bear]

Well stated.

[MarionP in reply to park_bear]

I think it is generally known that every time an antibiotic is used, many and entire species of "good" biotics, or unknown good or bad, biotics, are virtually entirely exterminated in the gut (I suppose elsewhere too), as well as the targeted infectant. This is not really a matter of speculation anymore.

What good functions are lost to such extinctions, one must wonder. But it is behind my doctor's frequent recommendation that being very quick with anti-biotics, while fully understandable and lately these days very indicated (now that so many infectious diseases are multiply resistant AND virulent), that their use be sober and considered indeed. Tough tradeoff. Get the wrong bacterium into your skin and you could have to amputate your arm within a week; naegleria will kill you in 2 days and there is no treatment for it at all. Anyway, collateral damage he says is almost always involved with antibiotics, and we don't even know what all we killed off that we need, along with the infection we were targeting.

Then to the present study. There have been references to various infections taking out (killing) whole swaths of dopamine producing brain neurons. FWIW. Also not a matter of speculation.

So depending on the quality of the study and any associated studies, if there are any, we have the possibility of infection (both identified and treated...much less knowing at what stage and what general medical vulnerability the individual patients might have and differ in) ...and then infections that went unidentified and untreated), thus in the "control" group, yet doing damage. Antibiotics doing the damage all by themselves? Not ruled out. Some mix of antibiotics in the presence of their target infectant doing the damage? And of course how much of the sample, and the population it represented, was vulnerable to develop PD in the first place. Much work to do.

One thing for sure we already know or the field should know: antibiotics are by no means harmless. How many species of bacteria that our bodies need to thrive on are killed each time they are used? My doctor says it not yet possible to know, but extinction of many species occurs with every use, which also means, he tells me, that the extinctions accumulate. At some point, what point (?), things (what things?...he says he doesn't know) can happen. But at least our crop and livestock output, in which the industry standard mega-use of antibiotics, is sky high, so traces and remnants of them can make their way into us regardless.

[Tribselyov in reply to MarionP]

What is FWIW..?

[MarionP in reply to Tribselyov]

"For what it is worth"

[Tribselyov]

NOT PROOF! Selection factors are at play in determining which patient is “assigned” to antibiotic group. My premise is that the more socially engaged (and more affluent) make more demands on the healthcare system (whether a private or government system) and they are more likely to get antibiotics. It follows that those who insist on antibiotic treatment early on... would ALSO be more likely to be diagnosed in earlier stages of PD. Thus, the conclusions may be flawed.

The demanding patient (often correlating with higher socio-economic status) is more apt to get a diagnosis of PD, whereas the less-demanding poor patient (lower socio-economic) just gets OLD.

I am retired after three decades of clinical surgery. Now with 7 yrs PD. Human nature has not changed in 3000 years.

There is nothing new under the sun.

[MarionP in reply to Tribselyov]

That's interesting. I guess many of us wouldn't know much about patient presentation patterns in Finland or know just how they did their selection of those receiving antibiotics or why. In USA a major problem is that just about everyone has had plenty of antibiotics due to patient demand for relief and prescribers sometimes being willing to prescribe for what they suspect could be viral infections, for which antibiotics are useless but at least don't alienate the patient.

It certainly was a neat quick sentence about selection, without comment about class/race differences or social patterns qualifying the social patient universe, method of diagnosis, and there wasn't much discussion in this paper. Were they correct in omitting such about Finland, is Finland really so homogeneous in all these ways that there need be no such considerations, or did they just not mention in the particular paper we get to see that they had taken all that into subject selection? Seems that their wording of antibiotics was based on "purchases." But in that country, do they not have entire-herd tracking on all prescription medications dispensed and all diagnoses issued? I guess from your comment they do not have a complete health care monitoring-treating lock on the entire herd? Guess I'm guilty of making a few unwarranted assumptions.

[pvw2]

This has many possible causes, but a definite conclusion that heavy use of antibiotics is not good.