Antibiotics – Side effects – NHS

Antibiotics can have side effects such as diarrhoea and feeling sick.

These side effects are usually mild and should pass once you finish your course of treatment.

If you get any additional side effects, contact your GP or the doctor in charge of your care for advice.

Antibiotic allergic reactions

Rarely, some people may have an allergic reaction to antibiotics, especially penicillin and cephalosporins.

In most cases, the allergic reaction is mild to moderate and can take the form of:

• a raised, itchy skin rash (urticaria, or hives)
• coughing
• wheezing
• tightness of the throat, which can cause breathing difficulties

These mild to moderate allergic reactions can usually be successfully treated by taking antihistamines.

But if you’re concerned, or your symptoms do not get better with treatment, call your GP for advice. If you cannot contact your GP, call NHS 111.

In rare cases, an antibiotic can cause a severe and potentially life-threatening allergic reaction known as anaphylaxis.

Call 999 or go to A&E now if:

• you have a skin rash that may include itchy, red, swollen, blistered or peeling skin
• you’re wheezing
• you have tightness in your chest or throat
• you have trouble breathing or talking
• your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

Tetracyclines and sensitivity to light

Tetracyclines can make your skin sensitive to sunlight and artificial sources of light, such as sun lamps and sunbeds.

Avoid prolonged exposure to bright light while taking these medicines.

Fluoroquinolones

Severe aches and pains

In very rare cases, fluoroquinolone antibiotics can cause disabling, long-lasting or permanent side effects affecting the joints, muscles and nervous system.

Stop taking fluoroquinolone treatment straight away and see your GP if you get a serious side effect including:

• tendon, muscle or joint pain – usually in the knee, elbow or shoulder
• tingling, numbness or pins and needles

Heart problems

Fluoroquinolone antibiotics can cause serious side effects in people who are at risk of heart valve problems.

Stop taking fluoroquinolone treatment straight away and see your GP if you get a serious side effect including:

• swollen ankles, feet and legs (oedema)
• new heart palpitations (heartbeats that suddenly become more noticeable)
• sudden shortness of breath

Reporting side effects

The Yellow Card Scheme allows you to report suspected side effects from any type of medicine you’re taking.

It’s run by a medicines safety watchdog called the Medicines and Healthcare products Regulatory Agency (MHRA).

Page last reviewed: 11 November 2022
Next review due: 11 November 2025

Learn about Different Types of IV Antibiotics

Learn about Different Types of IV Antibiotics | Care+Wear

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Many of you have asked us about IV antibiotic therapy. In this updated post, we will cover the following range of topics:

What are Intravenous Antibiotics?

Intravenous antibiotics are antibiotics that are administered directly into a vein so that they can enter the bloodstream immediately and bypass the absorption in the gut. It is estimated that more than 250,000 patients in the US receive outpatient IV antibiotics to treat bacterial infections. Typically, they are arranged by a physician that specializes in infectious disease.

Types of IV Antibiotics

The main classes of antibiotics are as follows:

• Cephalosporins such as cefepime (maxipime), cefazolin (Ancef), ceftriaxone (Rocephin)
• Fluoroquinolones such as moxifloxacin (Avelox), ciprofloxacin (Cipro) and levofloxacin (Levaquin)
• Penicillin such as piperacillin/tazobactam (Zosyn)
• Glycopeptides such as Vancomycin, Daptomycin, Dalbavancin (Dalvance), Oritavancin (Orbactiv), Telavancin (Vibativ)
• Nitroimidazoles such as metronidazole (Flagyl)
• Oxazolidinone such as Linezolid (Zyvox)
• Carbapenems such as Meropenum (Merrem)

Antibiotic Delivery through IVs

According to the National Library of Medicine, IV antibiotics are often used for bacterial infections in the lungs, hearts, bones, soft tissue, and brain. They can be used to treat bacterial infections that are resistant to traditional oral medications. Likewise, a combination of different antibiotics can be used to treat multidrug-resistant bacterial infections. Antibiotics fight infection caused by bacteria, and intravenous antibiotics are used for infections that are resistant to oral antibiotics or for infections that may require high doses of antibiotics that cannot be taken orally.

Receiving Antibiotic Treatment through IVs

Most of the time, intravenous (IV) antibiotic treatment is provided in a hospital. However, when it is safe and appropriate, antibiotic therapy can effectively treat patients at home or another healthcare facility. Each year, over 250,000 patients are successfully treated with IV antibiotics at home.

The antibiotic is administered through a small narrow flexible tube called a catheter or IV line, which is inserted into a vein using a needle. The needle is removed, and the IV line is left in place and secured by a dressing. There are different types of IV lines available, and the one chosen for your treatment will depend on your veins and how long you will need the antibiotics.

For example, patients with small peripheral veins often utilize something called PICC lines (Peripherally Inserted Central Catheters), where medication is administered directly to the heart. Considering PICC lines must be flushed daily, and their dressings have to be inspected and changed, patients with PICC lines must avoid getting them wet or dirty.

Guidelines for Administering through a PICC Line

• Wash your hands. Use warm water and soap to scrub for 1 minute. Wash between fingers and rinse thoroughly.
• Dry your hands. Use a fresh paper towel and use it to turn off the water so that you do not touch a dirty surface after washing. Set the paper towel aside, and throw it away after the IV care is done.
• Put gloves on. Always wear medical gloves when touching and administering IV antibiotics. Be sure to keep gloves clean at all times and discard after use.
• Prep injection site. Wipe down all IV antibiotics injection sites with alcohol prep before injection. Wipe the PICC line opening with alcohol before attaching it to the IV.
• Hang the IV bag. The drip chamber should be at least 18 inches above your head.
• Make sure everything is clean and sterile. Always clean the catheter port with an alcohol wipe before use. Flush the catheter with saline or heparin as directed by your medical team.
• Attach IV and begin. Attach the IV tubing to your catheter and secure it with tape. Start the medication as directed by your doctor.

Common Concerns and Complaints

The most common risks associated with intravenous catheters include blockages, blood clots, and infection. Patients need to contact a healthcare professional if they notice any fever, swelling, pain, or redness in the arm with the catheter.

One common complaint of using IV antibiotics is the pain and irritation around the IV site. In some cases, the medication can burn as it runs through the veins. When experiencing pain at the IV site, it’s essential that the patient specifies what type of pain is present because a poorly inserted IV can lead to a leakage of medication to the adjacent tissue. When medication is leaking out of the vein, it can damage the surrounding tissues. If this happens, the site can appear swollen and red, and is extremely painful, which in turn means that a new IV needs to be inserted.

Warning Signs and Side Effects

The most common side effects associated with using IV antibiotics include rash, itch, diarrhea. Rarely the medications can cause abnormal kidney or liver laboratory test results. Your doctor may need to monitor for these side effects and adjusts the antibiotic when necessary. However, it is crucial to be aware of warning signs related to receiving IV therapy, including:

• Allergic reactions: itching, swelling of the throat, tongue, rash, etc
• Swelling of your vein or discoloration around the skin
• Numbness or tingling in the arm of the PICC line
• Air embolism (a bubble of air gets into the vein and travels to your heart or lungs)
• If an IV comes out of your vein, first put pressure over the opening where the IV was until the bleeding stops and call your home health care agency or doctor right away.

Call your doctor, nurse, or healthcare professional if you have these signs of infection:

• Redness, swelling or bruising at the site where the needle enters the vein
• Pain
• Bleeding
• Fever over 100.5 °F (38.0 °C)

Call 9-1-1 immediately if you experience:

• Any breathing problems
• A fast heart rate
• Dizziness
• Chest pain

 

 

Updated: 3/17/2021

Reviewed by: Gregory Weingart, MD, a practicing ER physician, and Assistant Professor at the Eastern Virginia Medical School

 

 

If you are looking for more resources and support for those going using IV Antibitoics, check out our other blogs: 

What is a PICC Line?

Susan’s PICC Line Journey

What It’s Like Living With A Rare Disease: Cystic Fibrosis

Lindsay’s Fearless Fight Against Lyme

We love hearing from our community members! If you have any further questions, feel free to contact us for more information.

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Antibiotic elimination time from the body: what you need to know

Antibiotic elimination time depends on various factors, including the type of drug, dosage, metabolic characteristics of the patient. Find out how long the elimination process of an antibiotic can take and what factors can affect its speed.

Antibiotics are one of the most common and effective medicines for fighting infectious diseases. However, in order for the antibiotic to be able to completely remove pathogenic bacteria from the body, it is necessary to take into account the timing of its removal. As a rule, the antibiotic remains in the body for a certain time after the end of the dose, which can affect the effectiveness of its action and cause various side effects.

The timing of the elimination of an antibiotic from the body depends on several factors, including the type of drug, dosage, route of administration, and the general condition of the patient. Some antibiotics are cleared from the body fairly quickly, within hours or days, while others can remain in the body for weeks or even months.

It is important to remember that the misuse of antibiotics can lead to the development of bacterial resistance and weaken the effectiveness of the drug. Therefore, it is very important to follow the recommendations of the doctor regarding the dosage and timing of taking the antibiotic, as well as to complete the full course of treatment, even if the symptoms of the disease have disappeared.

Remember that self-treatment with antibiotics can be dangerous to your health and the health of others. Before starting antibiotic treatment, be sure to consult your doctor and follow his recommendations.

How long does it take to clear an antibiotic from the body?

The elimination time of an antibiotic from the body depends on several factors, including the type of antibiotic, dosage, route of administration, and individual characteristics of the organism. Antibiotics are usually cleared from the body within hours or days.

Some antibiotics are eliminated from the body faster, within a few hours. Others may stay in the body longer, up to several days. The elimination time may also depend on the function of the kidneys and liver, since these organs play an important role in the processing and elimination of drugs.

When choosing an antibiotic and determining the duration of its use, it is important to take into account the instructions for the drug, doctor’s recommendations and follow the indicated dosage. Incorrect use of antibiotics can lead to insufficient concentration of the drug in the body or, conversely, to its accumulation, which can lead to side effects and reduce the effectiveness of treatment.

It is important to remember that even after you stop taking an antibiotic, its residues may remain in the body for some time. Therefore, if you need to use other drugs or if side effects occur, you should consult your doctor to avoid interaction with the antibiotic.

Duration of the process

The duration of the process of removing the antibiotic from the body depends on several factors. First of all, this is due to the type and dosage of the drug taken. Some antibiotics may stay in the body longer, especially if they have a long half-life.

The function of the kidneys and liver also influences the duration of the process. If these organs work normally, then the antibiotic will be excreted from the body faster. However, in case of impaired renal or hepatic function, the elimination time of the drug may increase significantly.

The method of antibiotic application also plays an important role. For example, when taking the drug in the form of tablets or capsules, the elimination time may be longer than when administered intramuscularly or intravenously. This is due to the fact that when taken through the digestive system, the drug must go through a series of stages of digestion until its active components enter the bloodstream and begin to act.

In general, the duration of the process of removing the antibiotic from the body can vary from several hours to several days. For each specific drug, you should refer to the instructions or consult with your doctor to find out the exact timing of the withdrawal and ways to speed up this process, if necessary.

Factors affecting the timing

The timing of the elimination of an antibiotic from the body may depend on several factors that affect its metabolism and excretion from the body.

The first factor is the physiological characteristics of the organism. Each person has their own individual metabolic rate, which can affect the rate of elimination of the antibiotic. It is also important to take into account the age of the patient, his gender, the presence of chronic diseases and the state of the immune system.

Another factor is the type of antibiotic. Different antibiotics may have different half-lives, that is, the time during which the concentration of an antibiotic in the body is halved. Some antibiotics can be eliminated from the body in a few hours, while others can remain in the body for several days.

Also, the timing of the elimination of the antibiotic can be affected by its metabolic pathways. Antibiotics can be metabolized in the liver or excreted through the kidneys. If the function of the liver or kidneys is impaired, then this can slow down the process of removing the antibiotic from the body.

In addition, it is important to take into account the correct use of the antibiotic. If the patient does not follow the doctor’s recommendations on the frequency and duration of taking the antibiotic, this can lead to accumulation of the drug in the body and slow down its excretion.

Influence of dosage

The dosage of an antibiotic plays an important role in the rate of elimination of the drug from the body. The higher the dosage, the faster the antibiotic will be metabolized and excreted from the body. However, it should be remembered that a high dosage may also lead to an increase in side effects such as nausea, vomiting or diarrhea.

At low doses, the antibiotic may be slowly metabolized and remain in the body for a longer time. This can lead to an insufficient concentration of the drug in the blood and reduce its effectiveness in fighting infection. Therefore, doctors recommend that you follow the indicated dosage and not change it without consulting a medical specialist.

It is important to note that the dosage of the antibiotic may vary depending on the age of the patient, the type of infection and its severity. Children and the elderly, as well as patients with a weakened immune system, are often prescribed lower dosages to avoid possible side effects and weaken the body.

Features of different antibiotics

Each antibiotic has its own unique pharmacokinetics, which determines its rate of elimination from the body. Some antibiotics can be rapidly metabolized and excreted through the kidneys, while others can remain in the body for a long time.

For example, amoxicillin, a widely used antibiotic, is usually eliminated from the body via the kidneys within 6-8 hours. This means that its dosage can be taken every 8 hours to maintain an effective concentration in the body.

On the other hand, azithromycin, which is also a popular antibiotic, can stay in the body for a long time, especially in tissues. Its elimination half-life from the body can take up to 68 hours. This allows you to take it in a more infrequent mode, for example, once a day.

Another example is ceftriaxone, which has a long half-life in the body, reaching 5-9 hours. This allows it to be used in the treatment of infections with a high concentration of the drug for a long time.

It is important to remember that the timing of elimination of antibiotics may vary depending on many factors such as age, liver and kidney function, and the presence of other drugs in the body. Therefore, you should always consult your doctor or pharmacist for accurate information about the timing of the withdrawal of a particular antibiotic.

The role of the liver and kidneys

The liver and kidneys play an important role in the elimination of antibiotics from the body. The liver is the main organ responsible for processing and metabolizing antibiotics. It breaks down antibiotics into simpler components, which can then be excreted from the body through the kidneys or bile.

The kidneys filter the blood and remove waste from the body. When antibiotics pass through the kidneys, they can be excreted in the urine. The kidneys also play an important role in regulating water and electrolyte levels in the body, which can affect the rate of elimination of antibiotics.

In general, the liver and kidneys play an important role in the elimination of antibiotics from the body. Understanding this role can help guide the development of appropriate dosing and individual patient considerations when prescribing antibiotics.

Effects of food and liquids

Foods and liquids that we take with antibiotics can affect how quickly the drug is eliminated from the body. Some foods and drinks can slow down or speed up this process.

Food:

• Fatty and heavy foods can slow down the absorption of the antibiotic into the blood, resulting in a slower removal of the drug from the body.
• Acidic foods such as citrus fruits and juices can speed up the elimination of the antibiotic from the body.
• Foods containing calcium (eg milk and dairy products) may interfere with antibiotic absorption and excretion.
• Alcohol can interfere with the effectiveness of the antibiotic and slow down its elimination from the body.

Liquids:

1. Water is the main component of urine, which plays an important role in the excretion of the antibiotic from the body. Therefore, regular consumption of a sufficient amount of water can contribute to a faster elimination of the drug.
2. Caffeine found in beverages such as coffee and tea may have a diuretic effect, increasing the elimination of the antibiotic from the body.
3. Carbonated drinks and alcohol can cause diuresis, which can also speed up the elimination of the antibiotic.

It is important to remember that the effect of food and fluids on the elimination of an antibiotic can be individual and depends on many factors, including the type of antibiotic, dosage, general body condition and other factors. Therefore, before using an antibiotic, it is recommended to consult a doctor or pharmacist.

Withdrawal time in children and adults

Antibiotic elimination time from the body may differ between children and adults. In children, the metabolic process is faster, so the timing of the withdrawal of antibiotics from their body may be shorter. However, this does not mean that antibiotics should be used without restrictions in children.

Determining the timing of withdrawal of antibiotics in children and adults depends on many factors, including the type of antibiotic, dosage, liver and kidney status, and age of the patient. Some antibiotics can be rapidly eliminated from the body, while others may linger and remain active in tissues for longer.

It is important to remember that prolonged use of antibiotics can lead to the development of antibiotic resistance. Therefore, when using antibiotics in children and adults, it is necessary to follow the dosage rules and prescribe them only when necessary. It is also recommended that you consult with your doctor to find out the exact timing of the withdrawal of a particular antibiotic and take all measures to prevent the development of resistance.

Q&A:

How long does an antibiotic stay in the body?

The elimination time of an antibiotic from the body depends on various factors, including the type of antibiotic, dosage, metabolic activity of the body, and the condition of the liver and kidneys. On average, the antibiotic is completely eliminated from the body in 5-10 days.

What factors can affect the withdrawal time of an antibiotic?

The elimination time of an antibiotic from the body can be affected by various factors, such as the age of the patient, the functional state of the liver and kidneys, the presence of other diseases, as well as the use of other drugs at the same time.

Is it possible to speed up the process of removing an antibiotic from the body?

In most cases, the process of removing the antibiotic from the body cannot be accelerated. However, there are several ways that can help the body process and eliminate the antibiotic more efficiently, such as drinking more water to increase urine output and speed up the elimination of the antibiotic through the kidneys.

Can prolonged use of antibiotics lead to their accumulation in the body?

Yes, prolonged use of antibiotics can lead to accumulation in the body. This can be especially problematic for antibiotics that are metabolized in the liver or excreted through the kidneys. Therefore, it is recommended to strictly follow the doctor’s recommendations on the dosage and duration of antibiotics.

What can happen if you stop taking antibiotics early?

Stopping antibiotics prematurely can lead to inadequate bacterial killing and antibiotic resistance. This can lead to recurrence and complicate future treatment. Therefore, it is recommended to always complete the course of antibiotics to the end, even if the symptoms of the disease have already disappeared.

Can antibiotics cause side effects after they stop taking them?

The length of time an antibiotic remains in the body depends on various factors, including the type of antibiotic, dosage, the individual’s metabolic pattern, and organ function. Antibiotics are usually cleared from the body within a few days, but some may stay in the body for longer, especially if the person has kidney or liver problems. It is best to consult with your doctor to find out the exact time of withdrawal of the antibiotic from the body in your particular case.

Can antibiotics be taken at the same time as other medicines?

Some antibiotics can interact with other medicines, so check with your doctor or pharmacist before taking antibiotics. They can tell you about possible interactions and recommend changing the dosage or timing of your medications to avoid unwanted effects. It is important to tell your doctor about all the medicines you take, including prescription and over-the-counter drugs, vitamins, and supplements.

Can I drink alcohol while taking antibiotics?

Avoid drinking alcohol while taking antibiotics. Alcohol can interfere with the effectiveness of antibiotics and increase their side effects. In addition, alcohol can have a negative effect on the immune system, making recovery difficult. If in doubt, it is best to consult your doctor.

What if I miss an antibiotic?

If you miss an antibiotic, it is important to check with your doctor or pharmacist. They can tell you what to do in your particular case. You may be advised to take the missed dose, but this may not be desirable in some cases. In any case, do not double the dosage to make up for a missed dose without consulting a specialist.

Importance of following your doctor’s advice

Following your doctor’s advice is an important part of successful antibiotic treatment. Improper use of the drug can lead to undesirable consequences and complications of the disease.

The doctor prescribes an antibiotic in a certain dosage and for a certain number of days. Compliance with these recommendations allows you to achieve maximum effectiveness of the drug. With the premature termination of the course of treatment, the resumption of infection is possible, and if it is continued for a longer time than recommended, resistance of microorganisms to the antibiotic may occur.

It is also important to follow your doctor’s instructions for taking antibiotics. Some medications should be taken on an empty stomach, while others should be taken with food. Violation of these recommendations may reduce the effectiveness of the medicine or cause side effects.

Your doctor can also make recommendations about the compatibility of the antibiotic with other drugs or food. Some antibiotics interact with certain drugs or foods, which can cause the drug to not work as well or cause side effects. Therefore, it is important to follow the recommendations of the doctor and not to take the antibiotic together with illegal drugs or products.

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What to eat an antibiotic with? What products will get rid of the side effects of drugs

What is the microbiota

Broad-spectrum antibiotics primarily affect the intestinal microflora. This is a community of microorganisms living in the gastrointestinal tract. It is from them that the state of our health largely depends, for example, strong immunity. The “good” bacteria living in the intestines simply do not allow pathogenic microorganisms to “attach” to the cells of our body and thereby protect us from various infections.

Depending on the state of the microbiota at the time the course of antibiotics is prescribed, the effect of drugs on the condition of people will be different. For example, there is such a thing as bacterial overgrowth syndrome (SIBO), when opportunistic bacteria and fungi multiply excessively in the intestines. Most often this happens due to errors in nutrition. Antibiotics will not affect fungi, but against the background of taking such drugs, both the number of beneficial bacteria and opportunistic microbes may decrease. And here there are two options. If initially there were few fungi in the microflora, a person either will not encounter side effects of antibiotics at all, or will feel better. At least the patient will decrease gas formation in the intestines. But if there was an overabundance of fungi in the microflora, the death of beneficial microorganisms will lead to a decrease in immunity and the fungi will begin to multiply especially actively. As a result, fungal diseases, such as thrush, may appear. This happens especially often if a person actively leans on simple carbohydrates (sweets, white bread), which provoke the growth of harmful microorganisms and fungi.

If everything was normal with the microbiota before a person started taking antibiotics, the drugs can lead to disruption of the gastrointestinal tract. The fact is that beneficial microorganisms that inhabit the intestines are needed not only for strong immunity, but also for the digestion of food. If they die, it threatens with indigestion, diarrhea. In most cases, these troubles appear on the 2-3rd day of taking antibiotics.

Microbiota – a community of microorganisms living in the gastrointestinal tract. It is from them that the state of our health largely depends, for example, strong immunity. The “good” bacteria living in the intestines simply do not allow pathogenic microorganisms to “attach” to the cells of our body and thereby protect us from various infections.

Foods not to be eaten!

To prevent antibiotics from harming your health, you will have to give up certain foods during treatment, primarily alcohol. After all, alcohol, in fact, is a poison for our cells. Yes, in a small amount it is also formed in our body, in the intestines when bacteria break down plant foods. And a healthy person can cope with small doses of this substance. But against the background of the disease, when the body is affected not only by viruses and bacteria, but also by antibiotics, alcohol intake is a blow to the detoxification system. She simply cannot stand this, and then problems with the liver cannot be avoided.

Another drink that we have to say goodbye to for a while is milk. Calcium contained in dairy products reacts with the components of antibacterial drugs, thereby deactivating them. As a result, the drugs simply won’t work. In addition, milk reduces the number of beneficial bacteria, and against the background of dysbiosis (imbalance between beneficial and conditionally pathogenic microflora), the ability to digest lactose, milk sugar, worsens. Therefore, in combination with milk, antibiotics can lead to fermentation in the intestines and bloating.

Also, while taking medication, it is worth minimizing the amount of carbohydrate foods, especially simple carbohydrates. As we have said, they can provoke the growth of opportunistic microflora.

Refuse spicy, fried, peppered foods – such food irritates the stomach mucosa, which is not in the best condition due to antibiotics. Fat should also be kept to a minimum – fatty foods overload the liver.

Nutrition while taking antibiotics should include foods that protect the mucosa of the gastrointestinal tract, and also support our friendly microflora. First of all, these are vegetables in which there is a lot of fiber (it is dietary fiber that serves as food for beneficial microflora). It can be celery, zucchini, eggplant, greens. You can include some fruits in the menu – too much of them is not recommended due to the rather high sugar content. But both vegetables and fruits need to be thermally processed (boiled, stewed, baked) – fermented fiber is faster and easier to digest by bacteria.

Do not forget about strong meat broths – they help protect and restore the intestinal mucosa. It is no coincidence that they are so often used in clinical nutrition.

Do not drink wine and milk!

Recovery

After taking antibiotics, you need to return to your usual diet gradually. On average, it takes 7-10 days. During treatment, the enzyme system suffers due to intoxication, so you should not overload the stomach. To begin with, gradually start eating raw vegetables and fruits, add some animal protein to the diet, gradually increase the amount of fat. At the recovery stage, be sure to include in the menu special fermented milk products enriched with beneficial microorganisms (the very “live” yogurts and kefir). Such fermented milk products should be consumed within a month after taking antibiotics.

And don’t be afraid that beneficial microorganisms contained in yogurt will die in gastric juice. Indeed, for most bacteria, the acidic environment of the stomach is detrimental. But strains resistant to the action of gastric juice are added to fermented milk products. Just keep in mind that yogurt or kefir is better to drink after a meal, when the stomach is full of food. In this case, most of the beneficial bacteria will reach the intestines unharmed.

Purge is cancelled!

Since antibiotics create an excessive load on the liver, there is an opinion that after treatment it is worth “cleaning” it with the help of various means.