Avoiding sugary foods while taking a course of antibiotics might help protect the diversity of your gut microbiome.

The array of bacteria in the gut plays a crucial role in supporting our digestion and our physical and mental health. But this diverse community can be disrupted by antibiotics, leading to digestive problems, fatigue and flare-ups of skin conditions. Stopping such disruption is particularly important for people with cancer, because greater gut microbiome diversity has been linked to .

To dig into this issue, at the Memorial Sloan Kettering Cancer Center in New York and his colleagues have studied 158 people with blood cancers. The participants were hospitalised for several weeks as they had chemotherapy to knock out their immune systems before an infusion of stem cells. To prevent potential infections, each person took at least one type of antibiotic.

The researchers monitored changes in the participants鈥� gut microbiomes by analysing stool samples. Crucially, they also knew exactly what people had eaten, and when they had eaten it. Each time a participant ordered a meal from the hospital kitchen, between 12 days before the stem-cell transplant and 49 days after, the food tray arrived with a questionnaire for recording the amount of each item they consumed.

鈥淲e were able to collect these frequently and fill in the gaps,鈥� says Peled. 鈥淪uppose a patient ate half a lasagne. We know the recipe and the standard serving size and the nutritional information of each ingredient. I think this is the closest anyone has ever come to precisely recording everything that goes in and linking it to what comes out.鈥�

The researchers recorded more than 40,000 food items, creating a dataset with a level of detail that is rarely possible in nutrition research. When they scoured it for patterns, they found that people who consumed more high-sugar foods while taking antibiotics ended up with a less diverse microbiome.

Having antibiotics in the 48 hours before the collection of a stool sample was linked to a drop in microbiome diversity. This varied from person to person, but for every 100-gram increase in consumption of food or drink that was high in sugar (equivalent to one large milkshake) during that time, that drop in total bacterial diversity was on average 24 per cent greater.

The combination of a sugary diet and antibiotic treatment also led to increased numbers of Enterococcus faecium bacteria, which can act as pathogens and cause severe hospital-acquired infections.

The sugar in the gut exacerbates problems caused by the antibiotics, says team member at NYU Langone 91色情片 in New York. By wiping out many gut bacteria, the antibiotics disrupt the balance of the microbiome, leaving a few 鈥渓ast man standing鈥� strains that aren鈥檛 necessarily the most beneficial to our health. 鈥淭hey have survived the assault and then we are feeding them with rocket fuel.鈥�

鈥淚t makes sense that potential pathogens are boosted by sugar,鈥� says at the University of Trento in Italy. This could directly favour pathogens that thrive on sugar but might not be able to break down fibre, and also boost them indirectly, because the beneficial bacteria they are competing with aren鈥檛 getting the fibre they need to recover from the antibiotic assault, he says.

Experiments in mice backed up the idea that sugar was responsible for boosting potentially pathogenic bacteria. Mice given the antibiotic biapenem while eating a high-sucrose diet had a 16.3-fold increase in the Enterococcus population in their guts by day three and a 33.4-fold boost by day six. Mice that ate the high-sugar diet without antibiotics kept their bacterial diversity.

Peled says they saw similar effects when mice were fed on a commercial fruit smoothie, which contained high levels of the sugar fructose.

New antibiotic could stave off drug-resistant gonorrhoea

Neisseria gonorrhoeae, the microbe responsible for gonorrhoea, is developing resistance to most antibiotics, which means we need new drugs to treat the condition. An antibiotic called zoliflodacin might be part of a solution

The work has implications for both inside and outside hospital. Doctors often recommend smoothies or milkshakes to people with cancer to boost nutritional intake. This recommendation might have to be re-evaluated if the individual is also taking antibiotics, says Peled.

Avoiding sugary foods while taking antibiotics could also be relevant to the wider world. 鈥淢any of us are motivated to find ways to protect the microbiome when we or our children are prescribed antibiotics. Limiting the intake of sugary foods offers a potential way to do that,鈥� says Peled. 鈥淚t鈥檚 very feasible, likely to be very low toxicity, very tolerable and very economical.鈥�

He points out that standard dietary recommendations involve avoiding excessive sugar intake, so it is something we should all be trying to do anyway.

A window opens for bacteria to recolonise your gut when antibiotics have disrupted the microbiome there, says Segata, who has shown that after a course of antibiotics. To encourage the return of a wide array of beneficial bacteria, he recommends eating a high diversity of plant-based foods.

Drug-resistant gonorrhoea is on the rise worldwide, but a new antibiotic could buy us more time before the emergence of completely untreatable strains of the bacteria, which is known to potentially raise the risk of infertility.

The sexually transmitted infection is estimated to affect annually. It occurs when the bacterium Neisseria gonorrhoeae infects various body parts, including the anus, urethra and genitals. Common symptoms include a burning sensation when urinating and unusual discharge from the vagina or penis. If left untreated, it can cause infertility and pregnancy loss.

The disease is usually treated with injectable ceftriaxone, the last antibiotic that works against most N. gonorrhoeae聽strains 鈥� but the bacterium is evolving resistance to this drug too. For instance, the World 91色情片 Organization found that, across 12 countries including Thailand, South Africa and Brazil, about 5 per cent of cases were ceftriaxone-resistant in 2024 鈥� .

If ceftriaxone fails, doctors usually turn to other antibiotics, but it鈥檚 only a matter of time until completely untreatable strains evolve. 鈥淲e are running out of options,鈥� says at the Global Antibiotic Research and Development Partnership. 鈥淚t鈥檚 been decades since a gonorrhoea drug has been approved.鈥�

Attempting to stall this growing threat, researchers previously found that gepotidacin, an antibiotic pill used against urinary tract infections, can effectively treat gonorrhoea, with the US Food and Drug Administration (FDA) expected to make an . But since bacteria usually evolve resistance to new drugs, the more treatment options we have, the better, says Luckey.

She and her colleagues have now tested another drug, zoliflodacin, which was specifically developed to treat drug-resistant gonorrhoea. The researchers randomly assigned 744 people with gonorrhoea 鈥� from the US, South Africa, Thailand, Belgium and the Netherlands 鈥� to take either zoliflodacin, or a combination treatment involving ceftriaxone and another antibiotic called azithromycin.

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By swabbing participants鈥� cervix or urethra six days later, on average, the researchers found that zoliflodacin had cleared about 91 per cent of the infections, while the equivalent figure was 96 per cent among those who received standard treatments. This means there was no significant difference between the treatments. Side effects, such as headache and nausea, were similar and transient in both groups.

The vast majority of the 744 cases were caused by strains that weren鈥檛 resistant to ceftriaxone or azithromycin. But a prior study showed that, in a lab dish, . As such, the results add to evidence that zoliflodacin could offer a fresh approach against gonorrhoea, not just as a first-line treatment but potentially when standard drugs fail, says Luckey. 鈥淚n places where you鈥檙e looking at frequent risk of resistance, there may be a greater appetite to use it sooner as a first-line treatment,鈥� she says. What鈥檚 more, the drug 鈥� which is taken orally 鈥� could offer a more convenient way to treat gonorrhoea than ceftriaxone, which some people avoid due to a fear of needles, she says.

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The researchers have already submitted their data to the FDA, which is expected to make an approval decision on 15 December, says Luckey.

If this is positive, approvals elsewhere, including in the UK, Europe and Asia, will probably follow soon after, says at Imperial College London, who wasn鈥檛 involved in the study.

Together with ongoing efforts to vaccinate against gonorrhoea, with the , gaining two new drugs could mark a turning point in the fight against drug-resistant gonorrhoea, says Short. 鈥淭his is great news,鈥� she says. 鈥淲e have yet to see on a population level what this could mean, but if we鈥檙e coming at it from two different directions 鈥� we鈥檝e got prevention and we鈥檝e got treatment 鈥� we should be able to make a bigger impact on reducing resistance.鈥�

The way antibiotics called polymyxins pierce the armour of bacteria has been revealed in stunning detail by high-resolution microscopy, which could help us develop new treatments for drug-resistant infections.

Polymyxins are commonly used as a last-resort treatment against some so-called gram-negative bacteria, which can cause infections such as pneumonia, meningitis and typhoid fever. 鈥淭he top three World 91色情片 Organization priority pathogens are all gram-negative bacteria, and this is largely a reflection of their complex cell envelope,鈥� says at Imperial College London.

Around their inner cell, these bacteria have an outer surface layer containing molecules called lipopolysaccharides, which act like armour. We knew polymyxins target this outer layer, but how exactly they disrupt it and then kill bacteria wasn鈥檛 understood; neither was why the drugs don鈥檛 always work.

Now, Edwards and his colleagues have used biochemical experiments and atomic force microscopy 鈥� in which a needle just a few nanometres wide creates an image of a cell by sensing its shape 鈥� to reveal that one of the two types of polymyxin used therapeutically, called polymyxin B, causes strange bulges to break out on the surface of the gram-negative bacterium E. coli.

Minutes after the protrusions appear, the bacterium begins to quickly shed its lipopolysaccharides, which the researchers detected in the solution it was in.

The researchers say the antibiotic鈥檚 presence triggers the bacterium to try to put more and more 鈥渂ricks鈥� of lipopolysaccharide in its defensive wall. But as it adds bricks, it is also shedding some, temporarily leaving gaps in its defences that allow the antibiotic to enter and kill it.

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鈥淭he antibiotics are a bit like a crowbar that helps these bricks come out of the wall,鈥� says Edwards. 鈥淭he outer membrane doesn鈥檛 disintegrate; it doesn鈥檛 fall off. But there are clearly gaps where the antibiotic can then get to the second membrane.鈥�

He and his colleagues also uncovered why the antibiotic doesn鈥檛 always work: it only affected bacteria that were active and growing. When bacteria were dormant, a state they can enter to survive environmental stress such as nutrient deprivation, the polymyxin B was ineffective, because it wasn鈥檛 producing its armour.

However, the researchers found that providing sugar to the E. coli cells woke them from this dormant state and, within 15 minutes, armour production resumed and the cells were killed. The same is expected to apply to the other polymyxin antibiotic used therapeutically, polymyxin E.

Edwards says it might be possible to target dormant bacteria by giving people sugars, but there are dangers to waking these pathogens from their dormant state. 鈥淵ou don鈥檛 necessarily want bacteria at an infection site to start multiplying rapidly because that has its own downsides,鈥� he says. Instead, he adds, it might be possible to combine different drugs to bypass the hibernation state without waking the bacteria up.

Surgery is typically a last resort for people with a chronically blocked or runny nose. But in some cases, it may actually work better than the antibiotics that are routinely prescribed to treat the condition.

Chronic sinusitis affects about and occurs when the mucus-producing cavities 鈥� sinuses 鈥� around the nose become inflamed. Common symptoms include a blocked or runny nose, a reduced sense of smell and facial pain, with these persisting for more than 12 weeks. The cause of the condition is usually unclear but may involve viral infections or a change to the nose microbiome.

The first line of treatment involves anti-inflammatory nasal sprays and flushing saline solution through the nose daily. But if symptoms persist, doctors often prescribe a three-month course of the antibiotic clarithromycin. This is used for its anti-inflammatory properties rather than its bacteria-killing properties, says at the University of East Anglia in the UK.

As a last resort, people can undergo surgery to widen the sinuses and remove any benign nasal growths, or polyps, which form and worsen symptoms in of cases. Yet no prior study has directly compared surgery with antibiotics.

To fill this gap, Philpott and his colleagues recruited more than 500 adults with chronic rhinosinusitis. In surveys, the participants rated the severity of 22 symptoms, such as facial pain and how runny their nose was, with an average score of 55 out of 110.

The team then randomly assigned the participants to take either a three-month course of clarithromycin, placebo pills or undergo nasal surgery. All the participants also used nasal sprays and rinsed their noses with saline.

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Six months later, those who took either clarithromycin or placebo pills reported a roughly 10-point reduction in the severity of their symptoms compared with before the treatment, a level that would noticeably improve their quality of life, says team member at King鈥檚 College London. But since the effect was seen in both the antibiotic and placebo groups, it was probably due to the nasal sprays and rinsing, she says.

Those in the surgery group saw a roughly 30-point improvement in their symptoms compared with before surgery, suggesting doctors should offer this instead of antibiotics, says Hopkins.

There is an important caveat, however. About 80 per cent of the participants had nasal polyps, possibly because the study took place during the covid-19 pandemic, and catching the coronavirus may trigger the , says Hopkins. Further studies are needed to check whether the results apply to those without polyps, who we know harbour different types of inflammation, she says.

An antibiotic that is commonly used to treat pneumonia rid mice of Lyme disease at a dose 100 times lower than the standard antibiotic therapy. This smaller dose, combined with the drug鈥檚 targeted action against the infection, meant the animals鈥� gut microbiomes were largely unaffected.

Lyme disease is caused by bacteria in the genus Borrelia that mainly spread among birds and small rodents, but people can get infected via the bites of ticks that have fed on the blood of such animals. Infections commonly lead to flu-like symptoms and a 鈥渂ull鈥檚-eye鈥� rash. If untreated, they can cause serious long-term complications, such as fatigue and aches.

Standard treatment involves taking a high dose of the antibiotic doxycycline twice daily for up to three weeks. This stops bacteria from making the proteins they need to survive, but it doesn鈥檛 selectively target Borrelia species. 鈥淚t wreaks havoc on the normal [gut] microbiome,鈥� says at Northwestern University in Illinois.

Looking for a more selective alternative, Jutras and his colleagues first tested how effectively more than 450 antibiotics, all approved by the US Food and Drug Administration, could kill Borrelia burgdorferi 鈥� the most common type of Lyme disease-causing bacteria 鈥� in a lab dish.

They then assessed how the top-performing drugs affected the growth of harmless or beneficial bacteria that are commonly found in the guts of people and mice, such as certain strains of Escherichia coli. This revealed that piperacillin, an antibiotic that is related to penicillin and is commonly used to treat pneumonia, most selectively targeted B. burgdorferi.

Next, the researchers injected 46 mice with B. burgdorferi. Three weeks later, they treated the animals with varying doses of either doxycycline or piperacillin twice a day for one week. The researchers found no signs of infection in the mice that received either a high dose of doxycycline or as little as a 100-fold lower dose of piperacillin.

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They also analysed stools from the mice before and after the antibiotic treatment and found that low-dose piperacillin had almost no effect on the levels of bacteria other than B. burgdorferi in the gut, whereas high-dose doxycycline heavily altered the gut microbiome.

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This is probably because a lower dose of antibiotic has less of an effect on gut microbial diversity, and because of piperacillin鈥檚 targeted action. 鈥淲ith piperacillin, we found it鈥檚 targeting a particular protein that鈥檚 essential for B. burgdorferi, but not other bacteria, to survive, so it鈥檚 remarkably efficient at killing this Lyme disease agent at low concentrations,鈥� says Jutras. This may help to preserve a healthy gut microbiome, which has been linked to a long, disease-free life.

But mice can respond differently to antibiotics than people do, says at Johns Hopkins University in Maryland. For instance, they often break down the drugs faster, which can alter their effectiveness. Jutras鈥檚 team hopes to test piperacillin in human Lyme disease trials within the next few years.

Gonorrhoea is resistant to nearly all antibiotics, but one commonly used for urinary tract infections (UTIs) may be able to treat drug-resistant cases.

The sexually transmitted infection (STI) is caused by Neisseria gonorrhoeae, a bacterium that can infect various parts of the body, including the genitals and urethra. Common symptoms include a burning pain when urinating and discharge from the vagina or penis. If left untreated, the infection can raise the risk of infertility and premature birth.

Standard treatment involves an injection of ceftriaxone, the last antibiotic that works against most N. gonorrhoeae strains, but some have evolved to resist this drug too, . 鈥淲e know drug-resistant strains will spread elsewhere. In fact, we鈥檝e already seen this with cases in North America and Europe that were imported from Asia,鈥� says at the University of Toronto in Canada, who wasn鈥檛 involved in the study.

If ceftriaxone doesn鈥檛 work, the , but it is only a matter of time before completely untreatable strains emerge, as bacteria are constantly evolving to evade antibiotics, says Allen.

In an attempt to buy some time, at pharmaceutical company GlaxoSmithKline in Pennsylvania and her colleagues looked at around 400 people with N. gonorrhoeae infections in their genitals and urinary tracts. About half were randomly assigned to take two oral doses of the antibiotic gepotidacin. , this isn鈥檛 recommended to treat gonorrhoea, but .

The remaining participants received a single injection of ceftriaxone plus one oral dose of azithromycin, which belongs to a different antibiotic class. Although taking these at the same time isn鈥檛 recommended by the WHO, combining azithromycin with the first-line treatment ceftriaxone sets a higher bar with which to compare gepotidacin against, says Allen.

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Between four and eight days later, the researchers analysed swabs from 370 of the participants, with the remaining ones having dropped out or returning poor quality samples. The team found that both treatment regimens cleared all of the participants鈥� infections.

鈥淚t鈥檚 incredibly promising,鈥� says Allen. 鈥淚t shows a new treatment that鈥檚 highly effective and is very much easier to administer than the current antibiotic that鈥檚 given as a shot in the arm or the buttocks.鈥�

The truth about the foods said to boost your immune system

Many foods thought to enhance our natural defences, such as orange juice and turmeric, don鈥檛 live up to the hype. Instead, the key to a healthy immune system lies in nurturing your gut microbiome

Although the study didn鈥檛 include people with ceftriaxone-resistant strains of infection, gepotidacin works by preventing N. gonorrhoeae from replicating its DNA, while ceftriaxone destroys the bacterium鈥檚 rigid outer layer. These different mechanisms of action may mean that strains with mutations that enable them to resist ceftriaxone shouldn鈥檛 yet be able to resist gepotidacin, says Allen.

Still, if gepotidacin became widely used, N. gonorrhoeae would probably eventually evolve resistance to it too, so it is important to tackle the STI in other ways, such as by developing a vaccine that prevents infections, says Allen. What鈥檚 more, checking what strains people carry before prescribing antibiotics could reduce the inappropriate use of such drugs, which can worsen resistance rates, she says.