AbstractBackgroundAntibacterials are among the most frequently prescribed medications. Antibacterial drugs have the unintended consequence of destroying healthy gut flora, which can lead to known adverse events such as Clostridium difficile infection. Given emerging research concerning the role of these microorganisms in the gut-brain axis and some limited epidemiological studies, the objective of this study was to determine if antimicrobial exposure is associated with increased risk for depression.MethodsNational Veterans Health Administration administrative data were used to identify 878,405 veteran patients prescribed an incident antimicrobial during calendar year 2018. Sequence symmetry analysis was used to compare the incidence of a depressive disorder in the 6 months before and after antibacterial exposure, with additional analyses conducted with other antimicrobial classes as negative controls including antifungals, antivirals, and nonsystemic antibacterials.ResultsAntibacterial initiation was associated with a small but significant increase in the risk of incident depression (symmetry ratio [SR] = 1.04, 95% confidence interval [CI]: 1.03, 1.05), which was limited to the first 8 weeks following exposure. The strength of association varied with categories of antibacterial spectrum, from SR = 0.98 (95% CI: 0.95, 1.01) with the narrowest spectrum regimens, to SR = 1.12 (95% CI: 1.09, 1.15) with the broadest regimens. No significant association with incident depression was observed for antifungals, antivirals, and nonsystemic antibacterials.ConclusionsAntibacterial exposure was associated with increased risk for a depressive disorder. These findings are consistent with emerging literature and support the need for further research investigating a causal relationship between antibacterial exposure and risk for adverse mental health outcomes.

01 Apr 2025·British Journal of Clinical Pharmacology

A 10‐year retrospective study of antibacterial‐induced thrombocytopenia in a women and children hospital using China Hospital Pharmacovigilance System and Visual Basic for Applications

Article

Author: Yang, Jianhui ; Pan, Xiuming ; Chen, Yao ; Lin, Wanlong ; Chen, Weida ; Zhuang, Wei ; Cai, Can

AimsWe aimed to investigate antibacterial‐induced thrombocytopenia using the China Hospital Pharmacovigilance System (CHPS) in conjunction with Visual Basic for Applications (VBA).MethodsBetween September 2011 and December 2022, a 2‐phase workflow was employed to identify antibacterial‐induced thrombocytopenia, including preliminary screening in phase (I) conducted by CHPS algorithms and causality assessment by trained pharmacists in phase (II) using VBA. The incidence of thrombocytopenia in each antibacterial was calculated, and comparisons were performed between paediatric and adult patients.ResultsCHPS algorithms identified 4080 cases from 485 238 admissions (including 223 735 admissions receiving at least 1 antibacterial treatment). After ruling out cases with chemotherapy and abnormal platelet count at admission, 3832 cases were available. Using VBA, pharmacists identified 1039 cases (1246 antibacterial treatments, 28 agents) as potential thrombocytopenia instances (κ = 0.89), with an incidence of 0.46%. All antibacterial treatments correlated temporally with thrombocytopenia. Carbapenems (meropenem 1.77%), glycopeptides (vancomycin 1.55%) and lincosamides (clindamycin 0.44%) were prominent causal groups. The highest incidences of thrombocytopenia in the cephalosporins and penicillins groups were ceftazidime (2.04%) and piperacillin/tazobactam (1.24%), respectively. Among all antibacterial treatments, clindamycin showed the shortest time to onset (TTO), and erythromycin showed the longest TTO. Paediatric patients exhibited a longer TTO (61 vs. 29 h), extended time to nadir (83 vs. 37 h), lower platelet nadir count values (110 vs. 92 × 109/L), and a higher severe case proportion (12.37 vs. 3.86%) when compared with adults.ConclusionDifferent antibacterial agents exhibit varying incidences of thrombocytopenia, with notable disparities between adults and children in the characteristics of thrombocytopenia.

01 Mar 2025·Journal of Small Animal Practice

Fungal dysbiosis following antibacterial monotherapy in canine otitis externa

Article

Author: Chang, Y. M. ; Loeffler, A. ; Hendricks, A. ; Frosini, S. M. ; Brennan, E. ; Bond, R. ; Juhola, J. ; Ferguson, E. A.

ObjectivesTo evaluate evidence of Malassezia overgrowth following successful topical antibacterial monotherapy of refractory canine bacterial otitis using semi‐quantitative cultures.Materials and MethodsTwenty‐nine dogs with bacterial otitis were treated topically with either fluoro‐quinolone [0.5% enrofloxacin (18 dogs, 19 treatment events, 25 ears) or 0.1% marbofloxacin (1 ear), with 0.1% dexamethasone] (“FQ”) SID, or 143 mg/mL piperacillin/18 mg/mL tazobactam (“PT”) BID (11 dogs, 14 treatment events, 19 ears) for 8 to 36 days (mean 20 days). At visits 1 (V1) and 2 (V2), ear swab tips were washed in PBS + Triton X‐100 and serial dilutions spread‐plated onto blood, MacConkey (37°C, 48 hours) and modified Dixon's agar (32°C, 14 days) to generate semiquantitative counts. Microbes were identified by phenotype and MALDI‐TOF.ResultsPrior to treatment, Pseudomonas aeruginosa was isolated alone or in combination with other bacteria in 14 FQ‐treated ears and 18 PT‐treated ears; the next most frequent bacteria were Streptococcus canis (8 FQ, 2 PT) and Staphylococcus pseudintermedius (8 FQ, 1 PT). The proportions of dogs' ears (excluding cross‐over treatments and contra‐lateral affected ears) from which bacteria were isolated were significantly reduced by treatment with both FQ (V1, 13/15; V2, 5/15) and PT (V1, 14/14; V2, 2/14). The proportions of dogs' ears from which yeasts (Malassezia pachydermatis, Candida spp.) were isolated were significantly increased by treatment in dogs treated with PT (V1, 1/14; V2, 14/14) but not FQ (V1, 3/15; V2, 6/15).Clinical SignificanceOtitis cases that receive potent antibacterial monotherapy must be monitored for yeast overgrowth.

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