I’ve just started an antibiotics course which is 4 times a day for 10 days and that got me wondering if they would be just as effective if I took them all and why not.
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think of it like an army (your immune system).
if you rent the army an entire stockpile of guns for one day, they won’t have anything to fight off the enemies (those not found, hidden, or there yet) the following days and may get over-run and beat.
however, renting the army weapons spread out across, say, an entire week, might be enough to win the war and no enemies will be left to ambush or attack 🙂
You could stab a person one time, and they might be ok. But it’s you stab them 40 times over 10 days, they are going to be a lot worse off.
Great thread. Another important consideration is toxicity. A large dose all at once could overwhelm multiple organs or organ systems. Things that kill bacteria aren’t so different from things that kill us in large enough doses.
Drugs are like food – you can’t just eat a week’s worth in an hour and hope you’re not hungry again till 8 days have passed. You have to keep a required amount in the system all the time to get the job done, and the body is constantly using what you put in so you have to keep topping it up.
Drugs are the same in that the digestive system which breaks down food and gets it to where it needs to get to doesn’t differentiate drugs from food. So after a while the drug is also broken down just like food, and the remnants are used up or excreted also just like food.
Lastly, there is a large amount of evolutionary overlap between all species. So the drug acting on say the pathogen’s cell membrane production system may also have a small effect on your cell membrane production system, and if you overdose on the drug that effect may be pronounced in your system. And any other off target side effects you’d get from the small dose you are meant to take would be huge if you took the entire course in one go.
There are couple words used to describe medicines approach to a drug regimen that i think are helpful to understanding this. The first word is Pharmacokinetics. You body absorbs, distributes,
metabolizes and excretes the drug at a rate specific to the drug, the concentration of the drug and is even unique to the individual to an extent. These competing additions and subtractions of the drug need to be considered, because the goal is to keep the concentration of the drug in the second important vocabulary word: the therapeutic range.
There is a certain concentration a drug that needs to be in your blood so that it has the desired effect, but there is also a concentration that will lead to undesirable side effects. If the drug is actually viable, the effective concentration should be less then the concentration that causes the adverse response.
With regard to antibiotics, we want them to basically kill off all of the pathogens, because leaving a small amount left, the infection could re-emerge. But not only that, the generations of bacteria that grow after the insufficient treatment of antibiotics would be the offspring of the bacteria that the antibiotics didn’t kill as easily. So natural selection makes the next use of that drug less effective.
So since we want to make sure we kill all the bacteria, we want the drugs to be above the effective range for a long time (maybe 10 days depending on the drug and pathogen.) But if you gave a dose so high that it stayed in the blood that long, not only would it be wasting drug because of the pharmacokinetics of it, but more importantly, it would be way above the therapeutic range and cause the adverse side effects.
Hope that’s clear, I know it’s ELI5, but i think the big science words can be helpful when they’re descriptive.
I done this by taking double doses so I could drink for my 21th birthday 🤣 found out the amount to od on the antibiotic and stayed under the limit lol
there are 2 effects that influence each other:
**first effect**
antibiotics pass through your body and are filtered out by the kidneys.
so you take an amount and (like alcohol) its gonna be out of your system in a couple of hours. Imagine this as an antibiotic rain.
Remember this for a bit and meanwhile thank your kidneys.
**the second effect**
Antibiotics are either bactericidal (they kill the bacteria) or bacteriostatic (they keep the bacteria from reproducing and growing). the first kind only needs one dosis to work. so we gonna focus on the second(and most common).
The way the second kind work is not by killing bacteria but by stopping them from reproducing. its important to unserstand this. (eli5 follows):
>Antibiotics work by interfering with the bacterial cell wall to prevent growth and replication of the bacteria. Human cells do not have cell walls, but many types of bacteria do, and so antibiotics can target bacteria without harming human cells
The important part is that it does not kill the bacteria but imagine it destroys the womb of the baby female bacteria (by making holes in it that get bigger as the bacteria grow), so when they grow they cant birth any more bacteria babys. after their parents die the population dies with them. all it takes is for a baby to get wet once.
there is a problem… 2 type of bacteria are left:
type1: already grown bacteria is not affected by this and thus can have more babies that are born and raised without this holes.
type 2: some few baby bacteria might have a small resistance(thick fur) to they might survive the first wave of rain. pouring more water at once does not help as the bacteria just needs to be soaked for longer in it.
therefore there are 2 consequences:
1 you cant just do a single spray of attack.
2 pouring the 10x dose wont help at all as one dosis does all the effect. the 10x dosis is washed out soon anyway (provided your kidneys dont get damaged first) and you WANT it to be washed out as well.
so what you want is to have a constant drizzle of this damaging agent over at least 2 or 3 generation of bacteria and at least also one lifetime of bacteria so make sure the current generation died and there are no more reproductive bacteria left. so you take the antibiotics every day to keep your body in a constant medicated state refreshing the rain wave over and over.
if you only have 1 or 2 waves then a small population is still left there.. your symptoms disappear but the small population reproduces and they come back..
whats even worse… remember type2 bacteria? the few ones with a small resistance? well now they are the only ones left and suddenly you have a population made of ONLY resistant bacteria. now your first antibiotic will not work anymore or will kill again only the weaker ones leaving even more resistant babies.
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