What Can Happen If You Get Antibiotics

Doxycycline, a tetracycline antibiotic pictured here, is one thing that can cause black hairy tongue. Photographer: Tannen Maury/Bloomberg News

</div> </div> <p>Want another reason to be careful about using antibiotics when you don’t need them? How about getting a black hairy tongue?</p> <p>Hair can be great. But not there. A tongue should have tongue not hair or something that looks like hair.</p> <p><a href="https://www.nejm.org/doi/10.1056/NEJMicm1800351" target="_blank" rel="nofollow noopener noreferrer" data-ga-track="ExternalLink:https://www.nejm.org/doi/10.1056/NEJMicm1800351">The <em data-ga-track="ExternalLink:https://www.nejm.org/doi/10.1056/NEJMicm1800351">New England Journal of Medicine</em> published a case study</a> about a&nbsp;55-year-old woman who really needed antibiotics but got something that she didn’t need.&nbsp;Yasir Hamad, M.D. and David K. Warren, M.D. at Washington University in St. Louis, Missouri, described what occurred after&nbsp;the female patient suffered severe crush injuries to both her legs in a motor vehicle accident and developed a wound infection caused by multiple species of bacteria. The doctors treated her with the following antibiotics: meropenem through an intravenous line and minocycline via her mouth.</p> <p>Within a week of the antibiotics being started, her tongue began turning a black color. The patient also became nauseous and developed a bad taste in her mouth. This tweet shows what the&nbsp;doctors saw:</p> <p> </p> <blockquote class="twitter-tweet"> <p dir="ltr" lang="en">A 55-year-old woman was admitted to the hospital after sustaining a severe crush injury to both legs in a motor vehicle accident. Which class of antibiotic can lead to this presentation? <a href="https://t.co/KfTyrPy9JE" target="_blank" rel="nofollow noopener noreferrer" data-ga-track="ExternalLink:https://t.co/KfTyrPy9JE">https://t.co/KfTyrPy9JE</a></p> <p>— NEJM (@NEJM) <a href="https://twitter.com/NEJM/status/1037070292827365376?ref_src=twsrc%5Etfw" target="_blank" rel="nofollow noopener noreferrer" data-ga-track="ExternalLink:https://twitter.com/NEJM/status/1037070292827365376?ref_src=twsrc%5Etfw">September 4, 2018</a></p> </blockquote> <p>Some images just can’t be unseen. The doctors suspected that the minocycline was causing the &quot;black hairy tongue&quot;, which is a medical term for having a black hairy tongue. Now, black hairy tongue is not a dangerous condition, but if offered the choice most would probably not choose to have the black hairy tongue. In the condition, the many little bumps (filiform papillae) on your tongue get longer and have a brownish-black discoloration so that they start looking like many different hairs. They are not really hairs so this is not a new Hair Club for Men treatment. The exact mechanism behind why this occurs is unknown.</p>

<p>A number of things can cause black hairy tongue. Poor oral hygiene is one. Tobacco is another if you need yet another reason to quit smoking. Mouthwashes that contain peroxide, witch hazel or menthol are an additional possibility, which would be ironic if you are using the mouthwash for dates. Dehydration can be the problem, so drink up. But you may want to be careful&nbsp;about drinking lots of coffee or tea, which can also be causes. Other possible culprits are medications with bismuth such as Pepto-Bismol or radiation therapy. And of course, there’s antibiotics, particularly those in the tetracycline class.</p> <p>Typically, black hairy tongue is not a permanent condition. You just have to remove the cause and practice good oral hygiene like brushing your tongue. For this patient, the doctors stopped the minocycline and started an alternative set of antibiotics. Within 4 weeks of this change and with good oral hygiene, her tongue went back to the way it was.</p> <p>How common is black hairy tongue? Well the link on this U.S. Department of Health and Human Services tweet describes it as a &quot;relatively common condition&quot;:</p> <blockquote class="twitter-tweet"> <p dir="ltr" lang="en"><a href="https://twitter.com/hashtag/DYK?src=hash&amp;ref_src=twsrc%5Etfw" target="_blank" rel="nofollow noopener noreferrer" data-ga-track="ExternalLink:https://twitter.com/hashtag/DYK?src=hash&amp;ref_src=twsrc%5Etfw">#DYK</a>: Black hairy tongue can be triggered by poor oral hygiene, use of medications (particularly antibiotics), tobacco use, and certain illnesses. Many cases can easily be resolved with a toothbrush or tongue scraper. <a href="https://t.co/fiMe4EAJro" target="_blank" rel="nofollow noopener noreferrer" data-ga-track="ExternalLink:https://t.co/fiMe4EAJro">https://t.co/fiMe4EAJro</a> <a href="https://twitter.com/hashtag/FactFriday?src=hash&amp;ref_src=twsrc%5Etfw" target="_blank" rel="nofollow noopener noreferrer" data-ga-track="ExternalLink:https://twitter.com/hashtag/FactFriday?src=hash&amp;ref_src=twsrc%5Etfw">#FactFriday</a> <a href="https://t.co/kVTbIfpZob" target="_blank" rel="nofollow noopener noreferrer" data-ga-track="ExternalLink:https://t.co/kVTbIfpZob">pic.twitter.com/kVTbIfpZob</a></p> <p>— HHS.gov (@HHSGov) <a href="https://twitter.com/HHSGov/status/1038060508136591360?ref_src=twsrc%5Etfw" target="_blank" rel="nofollow noopener noreferrer" data-ga-track="ExternalLink:https://twitter.com/HHSGov/status/1038060508136591360?ref_src=twsrc%5Etfw">September 7, 2018</a></p> </blockquote> <p>How does that make you feel? However, it is not clear exactly how often antibiotics can cause this condition.</p> <p>Nonetheless, add black hair tongue to the list of reasons not to get antibiotics unless you really need them. Yes, this woman in the case study required antibiotics. But many people are getting antibiotics unnecessarily. Antibiotics are not candy. Licorice can lead to a black tongue but not increasing antimicrobial resistance or a black hairy tongue<span>.</span></p>”>

Doxycycline, a tetracycline antibiotic pictured here, is one thing that can cause black hairy tongue. Photographer: Tannen Maury/Bloomberg News

Want another reason to be careful about using antibiotics when you don’t need them? How about getting a black hairy tongue?

Hair can be great. But not there. A tongue should have tongue not hair or something that looks like hair.

The New England Journal of Medicine published a case study about a 55-year-old woman who really needed antibiotics but got something that she didn’t need. Yasir Hamad, M.D. and David K. Warren, M.D. at Washington University in St. Louis, Missouri, described what occurred after the female patient suffered severe crush injuries to both her legs in a motor vehicle accident and developed a wound infection caused by multiple species of bacteria. The doctors treated her with the following antibiotics: meropenem through an intravenous line and minocycline via her mouth.

Within a week of the antibiotics being started, her tongue began turning a black color. The patient also became nauseous and developed a bad taste in her mouth. This tweet shows what the doctors saw:

Some images just can’t be unseen. The doctors suspected that the minocycline was causing the “black hairy tongue”, which is a medical term for having a black hairy tongue. Now, black hairy tongue is not a dangerous condition, but if offered the choice most would probably not choose to have the black hairy tongue. In the condition, the many little bumps (filiform papillae) on your tongue get longer and have a brownish-black discoloration so that they start looking like many different hairs. They are not really hairs so this is not a new Hair Club for Men treatment. The exact mechanism behind why this occurs is unknown.

A number of things can cause black hairy tongue. Poor oral hygiene is one. Tobacco is another if you need yet another reason to quit smoking. Mouthwashes that contain peroxide, witch hazel or menthol are an additional possibility, which would be ironic if you are using the mouthwash for dates. Dehydration can be the problem, so drink up. But you may want to be careful about drinking lots of coffee or tea, which can also be causes. Other possible culprits are medications with bismuth such as Pepto-Bismol or radiation therapy. And of course, there’s antibiotics, particularly those in the tetracycline class.

Typically, black hairy tongue is not a permanent condition. You just have to remove the cause and practice good oral hygiene like brushing your tongue. For this patient, the doctors stopped the minocycline and started an alternative set of antibiotics. Within 4 weeks of this change and with good oral hygiene, her tongue went back to the way it was.

How common is black hairy tongue? Well the link on this U.S. Department of Health and Human Services tweet describes it as a “relatively common condition”:

How does that make you feel? However, it is not clear exactly how often antibiotics can cause this condition.

Nonetheless, add black hair tongue to the list of reasons not to get antibiotics unless you really need them. Yes, this woman in the case study required antibiotics. But many people are getting antibiotics unnecessarily. Antibiotics are not candy. Licorice can lead to a black tongue but not increasing antimicrobial resistance or a black hairy tongue.

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