Antibiotic therapy is not an effective treatment for lower back pain with disc herniation, according to a study published this month in JAMA Network Open.When one or more of the rubbery pads of cartilage between vertebrae are displaced, it compresses the spinal nerves, causing pain. This diagnosis can coincide with low-grade bacterial infections in the discs, which is why antibiotics are sometimes prescribed when first-line treatments fail.
However, as Australian researchers note in their study, the efficacy of antibiotics in treating this pain, which affects an estimated 619 million people globally, is unclear and controversial. The results of previous clinical trials have been mixed.
The double-blind clinical trial included 170 people with lower back pain due to a displaced disc. Half the participants received an antibiotic called amoxicillin-clavulanate for 90 days; the other half received a placebo. All were asked to rate their pain on a 1-to-10 scale over 12 months.
Those in the amoxicillin-clavulanate group did not report less pain than the placebo group, independent of baseline pain.
“This study showed that the use of antibiotics for chronic LBP [lower back pain] with disc herniation, a common subgroup thought to benefit from this treatment, is not effective,” the study authors wrote.
The rise of drug-resistant bacteria
These findings have implications for the growing threat of antibiotic resistance. As the World Health Organization explains, misuse and overuse of these drugs “puts the gains of modern medicine at risk.” Physicians are cautioned to be diligent with antimicrobials, as the more these drugs are prescribed, the more opportunities for bacteria to mutate in ways that render commonly used medications ineffective.
The study’s findings imply that treating lower back pain with antibiotics is not only a waste of time and financial resources, but it also contributes to a growing existential threat that endangers global health.
“Uncertainty about the efficacy of antibiotics for LBP, combined with limited effective therapies, is driving their ongoing use, despite the potential for harm, because increased antibiotic prescribing could substantially contribute to antimicrobial resistance, the leading cause of death globally,” the authors said.