







































Highlights in Bioscience;


 

Highlights in BioScience             

ISSN: 2682-4043 

DOI:10.36462/H.BioSci.20204                                                                                                          

 

 

Highlights in BioScience                                                                                                                                                                           June 2020| Volume 3 

http://bioscience.highlightsin.org/ 

Page 1 of 3 

                                               

 

Perspective 
 

 

Open Access 

 
 

 

 

 

 

University of  Pécs, Medical School, Institute of 

Migration Health, Pécs, Szigeti st. 12., H-7624, 

Hungary 

 

 

Contacts of Authors  

 

 

 

* To whom correspondence should be 

addressed: Gábor Ternák 

 

Citation: Gábor Ternák (2020). Holistic 

solution to an old "mystery": the global role of 

antibiotic consumption patterns in the spread of 

certain non-contagious diseases in EU 

countries, Volume 3. Article ID 20204, 

dio:10.36462/H.BioSci.20204 

 

Received:  May 25, 2020 

 

Accepted:  June 13, 2020 

 

Published: June 20, 2020 

 
 

Copyright: © 2020 Ternák. This is an open 

access article distributed under the terms of the 

Creative Commons Attribution License, which 

permits unrestricted use, distribution, and 

reproduction in any medium, provided the 

original author and source are credited. 

 

Data Availability Statement: All relevant data 

are within the paper. 

 

Funding: The study was not supported by any 

grants. 

 

Competing interests: No conflict of interest 

can be declared. 

 

 

 

 

 

Holistic solution to an old "mystery": the global role of 

antibiotic consumption patterns in the spread of certain 

non-contagious diseases in EU countries 

 
Gábor Ternák 

 

Abstract 

   

       The discovery and extensive utilization of antibiotics are highly 

contributed to the considerable lengthening life expectancy of human 

beings. Antibiotics, mixed with animal fodder, produced considerable 

growth promoting effect and hence, extended the indications of antibiotics 

at a much higher level. The indiscriminate use of antibiotics quickly 

resulted in the emergence of poly-resistant pathogens and the extensive 

antibiotic pollution of the environment, particularly of the surface water 

and rivers trough human and animal excreta.  Along with extensive and 

ever increasing antibiotic consumption/pollution, the pandemic-like 

spreading of certain non-contagious diseases like obesity, diabetes (Type 

1-2 T1DM, T2DM), Alzheimer disease (AD), Parkinson disease, multiple 

sclerosis (MS) etc. started unfolding, which was called as a slow moving 

disaster, without having any appropriate explanation of the phenomenon. 

The parallel appearance of those “pandemics”, which appeared 

simultaneously with the extensive antibiotic consumption, might indicate 

some kind of association. As far as several publications have reported the 

crucial role of altered gut flora in the development of metabolic disorders 

(diabetes, obesity) and neurodegenerative diseases alike (PD, AD, MS), it 

might be suspected that antibiotics, acting through the modification of 

microbiome, could influence the morbidity (prevalence) of those, 

non-infectious diseases. This concept, described below, might serve as a 

unified explanation, not excluding other, contributing causative factors, 

for the phenomenon, outlined above.   

 

 

The discovery of penicillin by Fleming in 1937 and later of neomycin and 

streptomycin by Waksman opened a new chapter of science, discovering the 

miraculous effect of antibiotics on infectious diseases. After the introduction of 

penicillin, several broad spectrum antibiotics were discovered also, like 

aminoglycosides, quinolones, macrolides etc., but their indiscriminate use has led 

to serious consequences and the rapid development of poly-resistant or panresistant 

bacterial species, which produced practically incurable infections (1). Out of the 

approximately 5000 molecules considered as having an antimicrobial effect, one 

thousand was further investigated, and finally we have about one hundred 

commercially available antibiotics to treat infections. Most of those drugs are 

produced by actinomycetes molds and different bacteria. After the „golden age” of 

antibiotic discovery of ’50-ies and ’60-ies and the extensive utilization of broad 

spectrum antibiotics in the late ’70-ies and ’80-ies, we now face the fact that the 

production of new classes of antibiotics practically stopped after 1987. 



 

 

Ternák 2020                                                                                                 The role of antibiotic consumption patterns in the spread of non-contagious diseases 

 

 

Highlights in BioScience                                                                                                                                                                           June 2020| Volume 3 

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At present, only few antibiotics are in the development, 

but it is not of certain that they might finally be used as 

commercially available antibiotics (2). The accidental 

discovery of the growth promoting potential of antibiotics in 

the late ’40-ies (3) resulted in the large scale utilization of 

antibiotics mixed to animal fodder which contributed to the 

extensive environmental pollution and the emergence of 

multi-resistant bacteria (genes) to the environment along 

with the development of human infections, practically 

untreatable with any antibiotics (4). Recently (2013) the 

yearly consumption of antibiotics in animal husbandry was 

estimated to be 131,109 tons (5).  The “growth promoting 

effect” of certain broad spectrum antibiotics (than 

Aureomycin) was observed and documented in premature 

newborns and school children also (6, 7). 

According to ECDC database of antibiotic consumption 

for 2018 expressed as the number of defined daily dose 

(DDD)/1000 inhabitants/Day, the average total consumption 

(community and hospital sector) of antibacterial for 

systematic use (ATC group J01) in the EU/EEA countries 

was 20.1 DDD/1000 inhabitants/Day (range: 9.7 – 34.0). 

During 2013-17, no statistically significant shift in antibiotic 

consumption was observed in the EU/EEA countries and no 

significantly increasing trends were reported (8). 

Usually, we consider as „epidemic” or “pandemic” the 

spreading of communicable diseases, but we have to face with 

the fact that the appearance and spreading of certain 

non-communicable diseases are similar. In the past few 

decades the pandemic like spread of several non- infectious 

diseases are alarming. The reason for the rapidly increasing 

amount of obesity, particularly childhood obesity, diabetes 

type 1-2 (T1DM, T2DM), autism, which was hardly heard of 

50 years ago, the Alzheimer disease (AD) of which produces 

more death in the USA, than cardiovascular and certain 

cancer deaths combined, and the Parkinson disease (PD) 

doubled its prevalence in the past 25 years. The prevalence of 

multiple sclerosis (MS) has increased by approximately 10% 

since 1990. Due to their outstandingly rapid spread, diabetes, 

obesity, autism, AD, PD and MS can be considered as of 

major importance.  This phenomenon is called as a slow 

moving disaster (9, 10). 

Scientists working on the explanation of this 

phenomenon, keep on digging deep to identify the molecular 

background, discovered several possible pathways and 

mechanisms leading to the development of those ailments 

and all of them emphasised the crucial role of the intestinal 

microbiome alteration (dysbiosis), but some external factors 

are suspected triggering the development of dysbiosis (11.). 

Several sequencing efforts were made to elucidate the 

complete composition of gut flora. Till now, 1952 

uncultured bacterial species were verified by reconstructing 

92,143 metagenome assembled-genomes from 11,850 

human gut microbiota, which is considered 281% increase 

in phylogenetic diversity (12). Antibiotics are powerful 

agents influencing the composition of the intestinal flora and 

producing dysbiosis, by reducing the diversity of the 

bacterial taxa in the gut. An extensive meta-analyses of 

articles dealing with the effect of antibiotics on the 

microbiome since the very first publication summarizes the 

observations. Penicillin has not much effect on the gut flora, 

but amoxicillin, amoxicillin/clavulanic acid, cephalosporins, 

macrolide, quinolone, lypopolyglycopeptide, ketolide, 

fosfomycin; tigecycline has increased the dominance of non 

E. coli (mostly Citrobacter, Enterobacter and Klebsiella 

spp.) Enterobacteriaceae. 

In contrary, most of the above antibiotics (amoxicillin, 

macrolide, clindamycin, quinolone, and sulfonamide) reduce 

the presence of E. coli in the gut flora, but the combination 

of amoxicillin/clavulanate has increased its abundance. 

Macrolide, doxycycline reduced the rate of Enterococcus 

spp. In the gut flora, while amoxicillin, piperacillin, 

ticarcillin, cephalosporin (1-4th generations), lypoglycopep- 

tides, carbapenem has enhanced their presence (13). 

Antibiotics reach our body as either therapeutic agents or 

from the environment, particularly from the heavily polluted 

rivers, because of the antibiotic enriched animal fodder, 

industrial waste and human excreta entering the surface 

water and ending up in the rivers and are present in the 

potable water also (14-16). 

The decisive role of dysbiosis in the process of 

developing certain chronic diseases might raise the theory 

that the quality and quantity of antibiotic insult on human 

microbiome might trigger the development of different 

diseases and antibiotic consumption preferences in different 

countries might be related to the different, emerging, non-

contagious diseases, showing pandemic-like spread. The 

issue that growth-promoting effect of antibiotics added to 

animal fodder of food animals might similarly affect humans 

as well, was first raised in 2005 (17).  

Further research by the author has led to the discovery 

of the significant selective correlation between childhood 

obesity and certain antibiotic consumption in EU countries 

(18). The significant association was found between the 

consumption of narrow spectrum penicillin and the 

prevalence increase of PD. Simultaneously, we observed the 

inhibitory effect of broad spectrum penicillin and the 

prevalence in PD as well (19). Further comparisons of large 

databases derived from ECDC (20) yearly reports of 

antibiotic consumption by EU countries (1997-2018) and 

the prevalence of diabetes (21) AD (22), and MS (23) 

derived from different resources (publications are in 

progress) demonstrated the promoting and inhibitory effect 

of different classes of antimicrobial agents on the 

development of those diseases. 

As a conclusion, I have detected two different, very 

distinctive patterns of antibiotic consumption, what I have 

called “Scandinavian type” with dominant consumption of 

narrow spectrum penicillin and tetracycline and higher 



 

 

Ternák 2020                                                                                                 The role of antibiotic consumption patterns in the spread of non-contagious diseases 

 

 

Highlights in BioScience                                                                                                                                                                           June 2020| Volume 3 

http://bioscience.highlightsin.org/ 

Page 3 of 3 

prevalence of PD (24), MS (23) and T1DM (21), and the 

“Mediterranean type” with dominant consumption of broad 

spectrum antibiotics, including broad spectrum penicillins, 

and higher prevalence of childhood obesity (25, 26), T2DM 

(21), and AD (22). Cross-association was observed with 

childhood obesity and AD. We found similar antibiotic 

consumption patterns in MS, and T1DM. This observation is 

being supported by the reported three fold higher prevalence 

of MS among patients with T1DM (27) and indicating the 

possible inhibitory effect of clavulanic acid in T1DM and 

MS. The holistic approach permitted us to consider the 

similarities of the parallel appearance and spreading of 

certain non-contagious pandemics, which appeared roughly 

at the same time as the widespread consumption of 

antibiotics.  Those findings clearly pointing to the possible 

common origin of the developing and spreading of certain 

non-contagious diseases included in the study and serve as 

an explanation for the “mystery” of the large scale spreading 

of obesity, diabetes, PD, AD and MS. 

 

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