Q:I am writing in connection with the article you wrote last year on antibiotics (Volume 2 No.2).
I had my spleen out at the age of 6. When I turned 18, it was decided by a specialist that I see at Hammersmith Hospital that I would need to take a daily dose of penicillin for the rest of my life, to safeguard against contracting meningitis, which could be fatal in my case.I seemed to be perfectly well for 12 years without the penicillin, so why I had to start it is a mystery to me.
I also suffer from very bad eczema, asthma and allergies, which have got so bad in the last six months that I have sought homoeopathic advice, as all my GP does is prescribe steroids, which I now know work only as a suppressant and do not actually cure anything.
I was very interested to read in your article that a continual dose of antibiotics can lead to a weakening of the immune system, leading to allergies, psoriasis and even multiple sclerosis.
I was horrified by this and have sent a copy of your article to my specialist to see if there is any way I can come off the penicillin. I am particularly worried as to the implications of taking penicillin during a pregnancy. R.W, London.......
A:Interestingly enough, a few months before we received your letter another reader wrote to tell us of two friends who had their spleens removed some years before as part of a now discredited treatment for Hodgkin's disease. She enclosed an information sheet from their GPs about what should be done for "preventative" treatment. "As they are both healthy, rarely even catching a cold, they are reluctant to weaken their immune systems by such 'unnecessary' medication", she writes.
The spleen has a role in resisting infection. Oftentimes, in the case of leukaemia and Hodgkin's disease, the spleen is removed when it no longer functions properly or when it becomes too big for comfort.
The spleen is the modern day appendix. Until recently, since doctors didn't understand what it did, they decided it wasn't all that necessary, and whipped it out with abandon. Now, however, we understand that the spleen has a crucial job in filtering certain bacteria out of the bloodstream in cases of severe infection. Two dangerous conditions frequently cited are pneumococcus infection, which can progress into septicaemia, or malaria. It is thought that being spleenless increases your risk by eight times if you're an adult, and 50 times if you're a child.
To put what sounds like a terrible risk in perspective, the risk of dying by extreme infection is only 1 in 30,000, so eight times that is 8 in 30,000, or nearly 1 in 4000.
The standard line supposedly to protect against these infections is to recommend vaccination against pneumococcal infection and "prophylactic antibiotics", particularly among children until 16. As the information sheet of our second reader demonstrates, prepared by Dr Dick Mayon-White, consultant public health physician in Oxford, "there is no standard medical opinion" on the dosage of antibiotics to take or the exact age at which to stop. Even the regular party line is that in spleenless adults, the risk of infections is low enough that "regular antibiotics may not be advisable".
"A person's own views about taking regular antibiotics should be taken into account, because there are varying opinions on whether these antibiotics are necessary," says Mayon-White
So in the case of our first reader, we would advise you to get a second opinion, since your doctor is acting contrary to conventional medical opinion.
Second, the effect of giving out long term just in case antibiotics may be to weaken the immunity of the individual and leave him open to all manner of other illnesses. "I personally think that the entire practice of prophylactic antibiotics is a very dubious concept," says Dr. John Mansfield, allergy and anti candida specialist whom we quoted in our issue.
Dr Mansfield remembers back in the 1960s hospitals in the States used to give prophylactic antibiotics for every operation, to prevent all infections. "Then some studies came out that showed that the post operative infection rate was no different whether or not they gave antibiotics. All that happened is that the bugs caught by the antibiotic group were resistent to penicillin or whichever antibiotic used and therefore probably more exotic.
"Theoretically it should have some use for rheumatic fever victims, during teeth extractions, so that any bacteria don't infect an already damaged heart. However, I often wonder if any one has done a survey on whether even this practice does any good at all. "
Still, Mansfield adds, there is a great difference between occasional use of antibiotics for teeth extraction and non stop "day in, day out use of antibiotics. I would expect with long term use that there would be a high level of candida albicans infection and candida toxins to inhibit a person's immune system, resulting in someone who was fairly immunocompromised. If I had a splenectomy, I'd need a lot of convincing evidence that using antibiotics actually worked."
Indeed, Mansfield points out, if a person without a spleen contracts an infection, you can at that point take antibiotics, which will work perfectly well.
The important point is to monitor yourself vigilantly.
At the first sign of infection (ie, fever, sore throat, unexpected cough, pain, rash) immediately seek medical advice. At that point, antibiotics may be a life saver.
A second method is to wear a Medic Alert bracelet or necklet, alerting doctors to the fact that you don't have a functioning spleen. You can obtain these from The Medic Alert Foundation, 12 Bridge Wharf, 156 Caledonian Rd, London N1 9UU . Besides having material on your bracelet, a central 24 hour emergency bureau will have details about your health on file for immediate reference.