🧪 Antibiotics, Fungal Risk, and ABPA: What Patients Need to Know

If you live with Allergic Bronchopulmonary Aspergillosis (ABPA) or another form of aspergillosis, you may be prescribed a range of treatments — including steroids, biologics, and sometimes antibiotics to prevent infections.

But how do these medications interact with each other? Could antibiotics make fungal conditions worse? And when should you use them?

This guide explains how different specialists, especially Infectious Diseases (ID) consultants, approach these questions, and what patients should know when balancing treatments for infections, inflammation, and immunity.

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💊 What Are Prophylactic Antibiotics and Why Are They Used?

“Prophylactic” antibiotics are low-dose medications taken regularly to prevent infections, rather than to treat a current one. You may be prescribed them if you:

• Have frequent chest infections due to asthma, bronchiectasis, or ABPA

• Are prone to urinary tract infections (UTIs), especially in winter

• Use long-term steroids, which can reduce your ability to fight bacterial infections

Examples include TRISOL (trimethoprim), azithromycin, or doxycycline.

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🦠 Can Antibiotics Make Fungal Problems Worse?

Yes — especially with long-term use. Here’s why:

• Antibiotics disrupt the natural balance of bacteria in the body

• This allows fungi like Aspergillus (or sometimes Candida) to multiply more easily

• The risk is higher in people taking steroids, biologics, or who already have fungal colonisation or sensitisation

So while antibiotics may prevent bacterial infections, they can increase the risk of fungal flare-ups — especially in the lungs.

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🧠 What Do Infectious Diseases (ID) Specialists Consider?

If you’re being seen by an ID team (such as at a specialist aspergillosis clinic), they will carefully assess the balance between preventing bacterial infections and not encouraging fungal overgrowth.

ID specialists tend to:

• Avoid long-term antibiotics unless absolutely necessary

• Pause antibiotics to allow accurate cultures to be taken

• Work with Respiratory and Urology teams to manage infections and inflammation together

• Consider non-antibiotic options for UTI prevention, such as:

  • Good hydration

  • Methenamine hippurate (Hiprex)

  • Vaginal oestrogen (in post-menopausal women)

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🧯 What About Steroids and Biologics?

• Steroids (like prednisolone) are important in controlling allergic inflammation in ABPA

  • But they also suppress the immune system

  • And raise blood sugar, which can fuel fungal growth

• Biologics (like omalizumab or dupilumab) are more targeted

  • They may allow you to use fewer steroids

  • But they still modulate the immune system, so infection risk must be monitored

When using steroids or biologics, ID teams may recommend:

• Close monitoring of fungal markers (e.g. IgE, Aspergillus PCR, sputum culture)

• Antifungal therapy alongside other treatments if needed

• Avoiding unnecessary antibiotics to keep fungal balance under control

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✅ When Might It Be Safe to Stop Prophylactic Antibiotics?

If you’re on long-term antibiotics for UTIs or chest infections, and your infection rate has dropped, it may be safe to pause prophylaxis. This is more likely if:

• Recent infections have been mild or infrequent

• Your Urology or Respiratory team agrees

• Cultures are negative, and symptoms are stable

• You have access to fast, “test and treat” options if a new infection occurs

In some cases, your doctor may stop antibiotics so blood and urine cultures can be taken without interference — to ensure any future treatment is accurate and appropriate.

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🧾 Key Takeaways

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🩺 A Word on Coordination

If multiple specialists are involved in your care (e.g. GP, Urology, Infectious Diseases, Respiratory), it’s important they communicate clearly. You may want to ask:

• “Can you confirm this plan with my other specialists?”

• “Do I need a fungal check-up before restarting antibiotics?”

• “Could we use a non-antibiotic prevention strategy instead?”

This will help avoid overlapping risks, conflicting advice, or missed infections.

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🗣️ Final Thought

In ABPA and other fungal conditions, it’s not a matter of choosing between bacteria or fungi — it’s about managing both carefully.

Antibiotics, steroids, and biologics all have a role — but they need to be used in balance, with infection risk, fungal exposure, and immune suppression monitored as a whole.