The psychological impact of gut-brain-axis modulation by broad spectrum antibiotics in acute leukemia patients treated with Larson induction protocol

Sami Hussein Mahmoud Hammadi; Azza Mohamed Baraka; salma hany kandiel

Sami Hussein Mahmoud Hammadi, Prof. Dr. Clinical Pharmacology Department, Faculty of Medicine, Alexandria University, Egypt.
Azza Mohamed Baraka, Prof. Dr. Clinical Pharmacology Department, Faculty of Medicine, Alexandria University, Egypt.
salma hany kandiel Clinical Pharmacology Department, Faculty of Medicine, Alexandria University, Egypt.

Keywords: Antibiotics, Gut-Brain-Microbiome axis, Chemotherapy, Leukemia, HADs.

Abstract

Background: Individual responses to a particular drug differ enormously in terms of efficacy as well as safety. In contrast to the human genome, gut microbial composition can be altered, making it an appealing target for enhancing therapeutic efficacy and safety. Antibiotic consumption deeply affects the composition of microflora. Perturbations of gut microbial ecology may trigger or exacerbate neuro-inflammation and behavioral comorbidities following chemotherapy. This study explored the possible impact of gut-brain axis modulation by broad spectrum antibiotics on the psychological status among hospitalized acute lymphoblastic leukemia (ALL) patients undergoing treatment with Larson induction chemotherapy protocol.

Methods: A cross sectional survey was conducted on 60 ALL patients undergoing treatment with Larson induction chemotherapy protocol and broad spectrum antibiotics. Patients were recruited from Internal medicine (Clinical Hematology Unit), Alexandria university hospital. In order to assess the depression and anxiety status we used a validated Arabic version of the Hospital Anxiety and Depression Scale (HADS).

Results: Among the studied cases 31.7% had normal depression score, (16.7%) had borderline depression score and (51.7%) had abnormal depression score. Meanwhile, (43.3%) had normal anxiety score, (33.3%) had borderline anxiety score and (23.3%) had abnormal anxiety score. A significant relation between both scores; depression and anxiety was detected among the studied patients (c²=24.962, ^MCp=<0.001). In addition, there was a significant increase in the duration of antibiotic therapy in patients having both borderline and abnormal depression/anxiety scores in comparison to patients with normal depression/anxiety scores. However, no significant difference was detected in the duration of antibiotic therapy between patients having borderline and abnormal depression/anxiety scores (H=33.097, p1=0.012, p2<0.001, p3=0.055) (H=20.460, p1<0.001, p2<0.001, p3=0.552).

Conclusions: Antibiotic use, specially the broad-spectrum type, for long duration, was associated with an increased risk of psychiatric problems.