THE EFFECT OF ANTIBACTERIAL DRUGS ON THE FECAL FLORA OF MICE

Antibiotic perturbations to the gut microbiome

Antibiotic-mediated perturbation of the gut microbiome is associated with numerous infectious and autoimmune diseases of the gastrointestinal tract. Yet, as the gut microbiome is a complex ecological network of microorganisms, the effects of antibiotics can be highly variable. With the advent of multi-omic approaches for systems-level profiling of microbial communities, we are beginning to identify microbiome-intrinsic and microbiome-extrinsic factors that affect microbiome dynamics during antibiotic exposure and subsequent recovery. In this Review, we discuss factors that influence restructuring of the gut microbiome on antibiotic exposure. We present an overview of the currently complex picture of treatment-induced changes to the microbial community and highlight essential considerations for future investigations of antibiotic-specific outcomes. Finally, we provide a synopsis of available strategies to minimize antibiotic-induced damage or to restore the pretreatment architectures of the gut microbial community.

Antibiotics in early life and obesity

The intestinal microbiota can influence host metabolism. When given early in life, agents that disrupt microbiota composition, and consequently the metabolic activity of the microbiota, can affect the body mass of the host by either promoting weight gain or stunting growth. These effects are consistent with the role of the microbiota during development. In this Perspective, we posit that microbiota disruptions in early life can have long-lasting effects on body weight in adulthood. Furthermore, we examine the dichotomy between antibiotic-induced repression and promotion of growth and review the experimental and epidemiological evidence that supports these phenotypes. Considering the characteristics of the gut microbiota in early life as a distinct dimension of human growth and development, as well as comprehending the susceptibility of the microbiota to perturbation, will allow for increased understanding of human physiology and could lead to development of interventions to stem current epidemic diseases such as obesity, type 1 diabetes mellitus and type 2 diabetes mellitus.

Risk factors for antimicrobial resistance in fecal Escherichia coli from preweaned dairy calves

The primary objective of this study was to investigate calf and farm factors associated with antimicrobial-resistant Escherichia coli in the feces of preweaned dairy calves in Sweden. In particular, we investigated the effects of feeding calves colostrum and milk from cows treated with antimicrobials. The secondary objective was to describe the prevalence of resistant E. coli in feces of preweaned dairy calves in Sweden. Fecal samples from 3 calves, aged 7 to 28d, from 243 farms were analyzed for the within-sample prevalence of E. coli resistant to nalidixic acid, streptomycin, and cefotaxime using selective agars supplemented with antimicrobials. In addition, resistance to 12 antimicrobials was tested in one randomly selected E. coli isolate per calf. Information was collected from the farmers via questionnaires regarding the use of colostrum and milk from cows treated with antimicrobials as calf feed and other uses of antimicrobials in the herd. Multivariable zero-inflated negative binomial and logistic regression models were used to assess the effect of various risk factors for shedding of resistant E. coli. Escherichia coli resistant to streptomycin, nalidixic acid, or cefotaxime were isolated from 90, 49, and 11% of the calves, respectively. Resistance to at least one antimicrobial was found in a random isolate of E. coli from 48% of the calves. Feeding colostrum from cows treated with antimicrobials at drying off did not affect the prevalence of resistant E. coli. In contrast, feeding milk from cows treated with antimicrobials during lactation resulted in significantly more nalidixic acid- and streptomycin-resistant E. coli than when such milk was discarded; no significant effect was seen for other resistance traits. Furthermore, an interaction was found between feeding milk from cows treated with antimicrobials and use of fluoroquinolones in cows. In general, the prevalence of resistance was lower for older calves and calves on small farms. Other factors that were associated with the shedding of resistant E. coli were administration of oral dihydrostreptomycin to calves, administration of systemic tetracycline and ceftiofur to cows and calves, housing of the calves, predominant breed of the herd, and geographic location of the farm. The presence of resistant E. coli in calves was clearly due to multiple factors, but minimizing the feeding of milk from cows treated with antimicrobials during lactation should lower the prevalence of resistant E. coli in the gastrointestinal tract of the calves.

Abnormal weight gain and gut microbiota modifications are side effects of long-term doxycycline and hydroxychloroquine treatment

Doxycycline has been proposed for the treatment of malnourished children in developing countries, and its use has been associated with weight gain in healthy volunteers. No previous studies have assessed abnormal weight gain as a putative side effect of long-term doxycycline treatment; thus, the objective of the present study was to characterize this phenomenon. We also analyzed the role of the gut microbiota in this effect. We assessed changes in the body mass index in Q fever endocarditis patients treated with doxycycline and hydroxychloroquine and healthy individuals with no antibiotic treatment. Abnormal weight gain was defined as a gain in weight above that of the controls. The fecal samples were examined using molecular assays for Methanobrevibacter smithii, Bacteroidetes, Firmicutes, Escherichia coli, Lactobacillus, Lactobacillus reuteri, and total bacterial concentrations. We examined 82 patients, including 48 patients with Q fever endocarditis and 34 controls. Approximately 23% of the treated patients showed abnormal weight gain (P = 0.001). Patients treated with doxycycline and hydroxychloroquine presented significantly lower concentrations of Bacteroidetes (P = 0.002), Firmicutes (P = 0.01), and Lactobacillus (P = 0.02). The linear regression analysis revealed that the duration of treatment was significantly associated with a decrease in Bacteroidetes (P = 0.0001), Firmicutes (P = 0.002), and total bacteria (P < 0.00001). Abnormal weight gain is a side effect of long-term doxycycline and hydroxychloroquine treatment. Gut microbiota modifications at the phylum level could play an instrumental role in this effect. We highlight the need for specific nutritional care in patients undergoing long-term antibiotic treatment, particularly treatment involving the use of doxycycline.

Effects of medicated diet to eradicate Helicobacter spp. on growth, pathology, and infection status in Rag1-/- and nude mice

The use of a commercial 4-drug diet has been shown to eradicate Helicobacter spp. from immunocompetent mice and those with innate immunodeficiencies. However the efficacy of this diet has not been confirmed in mice with altered adaptive immunity. We hypothesized that an 8-wk treatment with medicated diet would eradicate H. hepaticus and H. typhlonius from young naturally infected nude and Rag1 mice lacking functional T cells (Foxn1(nu)) or T and B cells (B6.129S7-Rag1(tm1Mom)/J), respectively. We evaluated helicobacter status, body weight, and gross and histologic changes between medicated and control diet in groups of infected and uninfected mice throughout treatment and at 8 wk after treatment completion. Initial infection status was confirmed by fecal PCR at weaning and 3 wk later, with study initiation in 7-wk-old mice. PCR testing demonstrated that independent of strain and sex, all treated mice tested negative for Helicobacter spp. after 4 wk of treatment and remained negative for the duration of the study. Irrespective of infection status, nude and Rag1 mice fed 8 wk of medicated diet gained less weight than did their untreated controls. Both strains normalized body weight while on control diet for the 8 wk after treatment. Mice fed medicated diet developed severe gastroesophageal hyperkeratosis, suggestive of reduced feed consumption, and enlarged ceca. These conditions improved or resolved after the return to control diet. This report is the first to demonstrate the efficacy and physical effects of providing medicated diet for the eradication of Helicobacter spp. from mice with adaptive immune deficiencies.

Infant antibiotic exposures and early-life body mass

OBJECTIVES

To examine the associations of antibiotic exposures during the first 2 years of life and the development of body mass over the first 7 years of life.

DESIGN

Longitudinal birth cohort study.

SUBJECTS

A total of 11 532 children born at 2500 g in the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based study of children born in Avon, UK in 1991-1992.

MEASUREMENTS

Exposures to antibiotics during three different early-life time windows (<6 months, 6-14 months, 15-23 months), and indices of body mass at five time points (6 weeks, 10 months, 20 months, 38 months and 7 years).

RESULTS

Antibiotic exposure during the earliest time window (<6 months) was consistently associated with increased body mass (+0.105 and +0.083 s.d. unit, increase in weight-for-length Z-scores at 10 and 20 months, P<0.001 and P=0.001, respectively; body mass index (BMI) Z-score at 38 months +0.067 s.d. units, P=0.009; overweight OR 1.22 at 38 months, P=0.029) in multivariable, mixed-effect models controlling for known social and behavioral obesity risk factors. Exposure from 6 to 14 months showed no association with body mass, while exposure from 15 to 23 months was significantly associated with increased BMI Z-score at 7 years (+0.049 s.d. units, P=0.050). Exposures to non-antibiotic medications were not associated with body mass.

CONCLUSIONS

Exposure to antibiotics during the first 6 months of life is associated with consistent increases in body mass from 10 to 38 months. Exposures later in infancy (6-14 months, 15-23 months) are not consistently associated with increased body mass. Although effects of early exposures are modest at the individual level, they could have substantial consequences for population health. Given the prevalence of antibiotic exposures in infants, and in light of the growing concerns about childhood obesity, further studies are needed to isolate effects and define life-course implications for body mass and cardiovascular risks.

Need for a comprehensive medical approach to the neuro-immuno-gastroenterology of irritable bowel syndrome

Irritable bowel syndrome (IBS) is defined by the Rome III criteria as symptoms of recurrent abdominal pain or discomfort with the onset of a marked change in bowel habits with no evidence of an inflammatory, anatomic, metabolic, or neoplastic process. As such, many clinicians regard IBS as a central nervous system problem of altered pain perception. Here, we review the recent literature and discuss the evidence that supports an organic based model, which views IBS as a complex, heterogeneous, inter-dependent, and multi-variable inflammatory process along the neuronal-gut axis. We delineate the organic pathophysiology of IBS, demonstrate the role of inflammation in IBS, review the possible differences between adult and pediatric IBS, discuss the merits of a comprehensive treatment model as taught by the Institute of Functional Medicine, and describe the potential for future research for this syndrome.

THE EFFECT OF ANTIBACTERIAL DRUGS ON THE WEIGHT OF MICE

NCS mice gained weight rapidly when fed a gluten diet deficient in several amino acids, but their weight gain on the same regimen was very much retarded if they were given antibacterial drugs, even for a short period of time. This retardation of growth could not be entirely corrected by supplementing the gluten diet with lysine and threonine. The decrease in growth rate brought about by antibacterial drugs could probably be traced to the alteration in intestinal flora resulting from drug treatment. The intensity and duration of both types of changes were related to the dose of drug administered, and to the length of the treatment period. Whatever the nutritional regimen, treatment with penicillin caused a retardation of weight gain in NCS mice. The retardation was more pronounced, and longer lasting, when the animals were fed semisynthetic regimens (containing casein or gluten) than when they were fed crude diets (pellets) containing natural materials of ill defined composition. These differences probably had their origin in the fact that the changes in fecal flora induced by the drugs were profoundly influenced by the composition of the diet. Antibacterial drugs which retarded weight gain of Swiss NCS mice, in contrast increased weight gain in ordinary Swiss mice raised under usual conditions. It is probable that this difference in response to the antibacterial drugs resulted from the fact that ordinary Swiss mice have a much more complex intestinal flora than NCS animals.

The "Microflora Hypothesis" of allergic disease

Predisposition to allergic disease is a complex function of an individual's genetic background and, as is the case with multi-gene traits, environmental factors have important phenotypic consequences. Over a span of decades, a dramatic increase in the prevalence of allergic disease in westernized populations suggests the occurrence of critical changes in environmental pressures. Recently, it has been shown that the microbiota (i.e. microflora) of allergic individuals differs from that of non-allergic ones and that differences are detectable prior to the onset of atopy, consistent with a possible causative role. Features of the westernized lifestyle that are known to alter the microbiota, such as antibiotics and diet, are also associated with allergy in humans. In this chapter, we discuss the "Microflora Hypothesis" for allergy which predicts that an "unhealthy" microbiota composition, now commonly found within westernized communities, contributes to the development of allergy and conversely, that restoring a "healthy" microbiota, perhaps through probiotic supplementation, may prevent the development of allergy or even treat existing disease. In testing this hypothesis, our laboratory has recently reported that mice can develop allergic airway responses if their microbiota is altered at the time of first allergen exposure.

The 'microflora hypothesis' of allergic diseases

Increasingly, epidemiologic and clinical data support the hypothesis that perturbations in the gastrointestinal (GI) microbiota because of antibiotic use and dietary differences in 'industrialized' countries have disrupted the normal microbiota-mediated mechanisms of immunological tolerance in the mucosa, leading to an increase in the incidence of allergic airway disease. The data supporting this 'microflora hypothesis' includes correlations between allergic airway disease and (1) antibiotic use early in life, (2) altered fecal microbiota and (3) dietary changes over the past two decades. Our laboratory has recently demonstrated that mice can develop allergic airway responses to allergens if their endogenous microbiota is altered at the time of first allergen exposure. These experimental and clinical observations are consistent with other studies demonstrating that the endogenous microbiota plays a significant role in shaping the development of the immune system. Data are beginning to accumulate that a 'balanced' microbiota plays a positive role in maintaining mucosal immunologic tolerance long after post-natal development. Other studies have demonstrated that even small volumes delivered to the nasopharynx largely end up in the GI tract, suggesting that airway tolerance and oral tolerance may operate simultaneously. The mechanism of microbiota modulation of host immunity is not known; however, host and microbial oxylipins are one potential set of immunomodulatory molecules that may control mucosal tolerance. The cumulative data are beginning to support the notion that probiotic and prebiotic strategies be considered for patients coming off of antibiotic therapy.

Does the microbiota regulate immune responses outside the gut?

Perturbations in the gastrointestinal (GI) microbiota composition that occur as a result of antibiotics and diet in "westernized" countries are strongly associated with allergies and asthma ("hygiene hypothesis"). The microbiota ("microflora") plays a crucial role in the development of mucosal tolerance, including the airways. Significant attention has been focused on the role of the microbiota in GI development, immune adaptation and initiation of GI inflammatory diseases. This review covers the post-developmental functions that the microbiota plays in regulating immunological tolerance to allergen exposure outside the GI tract and proposes the question: is the microbiota a major regulator of the immune system?

Clinical isolation and resistance patterns of and superinfection with 10 nosocomial pathogens after treatment with ceftriaxone versus ampicillin-sulbactam

Isolation of pathogens from clinical cultures and their resistance patterns may be altered by antecedent antibiotic treatment. The objective of this study was to assess the influence of treatment with ceftriaxone versus that with ampicillin-sulbactam on recovery and superinfections with 10 nosocomial pathogens. The study was designed as a historical cohort study, using a propensity score to adjust for confounding by indication and multivariate survival analyses to adjust for other confounding. Two thousand four hundred forty-five patients were treated with ampicillin-sulbactam, and 1, 308 were treated with ceftriaxone. The study analyzed two outcomes: (i) recovery of pathogens from clinical cultures and (ii) microbiologically documented infections. Data were obtained from administrative, pharmacy, clinical, and laboratory databases and by chart extraction. Following treatment, new isolation of at least 1 of the 10 target pathogens occurred for 244 patients. After adjustment, more infections occurred in the ampicillin-sulbactam group (hazard ratio [HR], 1.55; P = 0.009). This was observed with all gram-negative rods combined (HR, 3.6; P < 0.001) and with each genus of the family Enterobacteriaceae. No differences in isolation of gram-positive bacteria were evident (P = 0.33). Microbiologically documented superinfections occurred in 172 patients and were less frequent in the ceftriaxone group (3.8% versus 5%; HR, 1.6; P = 0. 015). All the Escherichia coli and Klebsiella spp. isolates were susceptible to ceftriaxone, but half were resistant to ampicillin-sulbactam. The prevalence of oxacillin resistance among Staphylococcus aureus isolates was higher in the ceftriaxone group (63% versus 31%; odds ratio, 3.8; P = 0.08). Differences in the rates of superinfections and the likely causative organisms following treatment with ceftriaxone or ampicillin-sulbactam were evident. This may guide clinicians in empirical choices of antibiotics to treat superinfection.

An anaerobic continuous-flow culture model of interactions between intestinal microflora and Candida albicans

The finding by earlier workers that Escherichia coli suppressed the growth of Candida albicans in vitro or in gnotobiotic mice has led to numerous, erroneous conclusions regarding the identity of the organisms and mechanisms responsible for the suppression of Candida in the gut. This is due, in part, to the fact that nearly all studies to date have not reflected interactions as they occur in the intestinal tract. This paper describes a series of experiments that establish that an anaerobic continuous-flow (CF) culture model of the ecology of the large intestinal flora reproduces interactions between bacteria and Candida as they occur in the large intestine. This was determined in the following ways. (i) Bacterial counts in CF cultures of conventional mouse cecal flora or human fecal flora closely resembled that found in the mouse intestine and human feces. (ii) Dense layers of bacterial growth that formed on the glass walls of the CF culture vessels resembled bacterial populations that colonize intestinal mucosa. (iii) Total and individual levels of certain metabolic end-products of the predominant anaerobic bacterial flora present in CF cultures coincided with those found in the large intestine of conventional mice or human feces used to establish the CF cultures. (iv) C. albicans was eliminated from CF cultures of mouse cecal flora at a rate similar to that of untreated experimental animals. (v) Contents of CF cultures fed to antibiotic-treated mice redressed several cecal abnormalities, and suppressed Candida populations to levels found in conventional animals. Thus, a number of complex ecological mechanisms were maintained in CF cultures which normally control Candida populations in the large intestine. It is suggested, therefore, that the CF culture model should help to further define the mechanisms which control C. albicans and other fungi in the intestinal tract, as well as define which components of the indigenous microflora are responsible for suppression of Candida in the gut.

Effect of various antibiotics on gastrointestinal colonization and dissemination by Candida albicans

Mice were treated orally with various antibiotics to determine which members of the indigenous intestinal microflora normally suppress Candida albicans colonization and dissemination from the gastrointestinal (GI) tract. The mice were given penicillin, clindamycin, vancomycin, erythromycin, or gentamicin for 3 days, and then challenged orally with C. albicans. Penicillin, clindamycin, and vancomycin, but not gentamicin or erythromycin, decreased the total anaerobic bacterial populations in the animals ceca, and increased the enteric bacilli population levels. All three of the former antibiotics allowed C. albicans to proliferate in the gut and, subsequently, disseminate from the GI tract to visceral organs. The ability of C. albicans to associate with intestinal mucosal surfaces was also tested. It was found that antibiotics which reduced anaerobic population levels, but not enteric bacilli or aerobes, also predisposed animals to mucosal association by C. albicans. It is suggested that the strictly anaerobic bacterial populations which predominate in the gut ecosystem are responsible for the inhibition of C. albicans adhesion, colonization and dissemination from the GI tract.

Colonization resistance of the digestive tract and the spread of bacteria to the lymphatic organs in mice

After oral contamination of conventional mice with high doses of Escherichia coli, Klebsiella pneumoniae or Pseudomonas aeruginosa the contaminant was recovered in abnormally high concentrations from the duodenum and caecum during the first few days. In this initial colonization phase, evidence of spread was obtained by culturing the cervical and mesenteric lymph nodes and spleen. Longer after contamination the intestinal concentration decreased to normal and spread stopped. In orally antibiotic-treated mice, the situation seen during the initial colonization phase in conventional mice occurred after a much lower oral contamination dose and persisted during the entire observation period of 2 weeks.

Cecal Enlargement and Microbial Flora in Suckling Mice Given Antibacterial Drugs

Enlargement and microbial colonization of the cecum were examined in neonatal mice suckling mothers drinking either water or an aqueous solution of penicillin. The full ceca increased in weight at the same rate in both drug-treated and control mice during the first 15 to 17 days after birth. Thereafter, cecal weight increased at a greater rate in the drug-treated animals than in the untreated controls. At weaning, the ceca in treated mice were two to three times the size of control organs and remained enlarged as long as penicillin was given. The enlarged ceca did not differ histologically from those in controls. From birth, the cecal microflora in the drug-treated mice differed qualitatively and quantitatively and in colonization pattern from the flora of control mice. The ceca of untreated animals were colonized primarily by large populations of lactobacilli during the first week after birth, small populations of coliforms and enterococci during the second week, and enormous populations of bacteroides and certain gram-negative fusiform-shaped anaerobic bacteria during the third week. In contrast, the organs of the treated mice were populated by large populations of coliforms and enterococci during the first week and enormous populations of clostridia and unusual gram-negative nonsporeforming bacteria during the third week. These large abnormal populations were present in the ceca as they enlarged during the third week after birth in the drug-treated animals. These findings confirm that only certain populations of anaerobic bacteria can act to maintain cecal size in normal animals.

Effect of antibiotics on intestinal absorption in mice

1. The effects of dietary antibiotics (penicillin, neomycin or terramycin) on the absorption of D-glucose, D-galactose, L-arginine or L-histidine by the mouse were investigated by using sacs of entire everted ileum.

2. Compared with the controls, there was generally an increased absorption of all these solutes. Tissue uptake of the solutes remained unaltered. The inward movement of water into the sacs was increased but was generally independent of solute transport.

3. The body-weight decreased slightly and caecal weight increased with penicillin only. The weight of the small intestine decreased with the different antibiotics, and the gut wall became thinner. Faecal fat increased slightly, but not significantly, with neomycin only. Water intake decreased with the different antibiotics.

Microbial interference between indigenous yeast and lactobacilli in the rodent stomach

Indigenous yeasts grow in layers in the mucus on the secreting epithelium of the stomachs of some strains of rats and mice raised under conventional conditions. Likewise, indigenous lactobacilli appear in layers on the nonsecreting epithelium of the stomachs of rats and mice. The two microbial layers can coexist in the same animals. When I gave such rodents penicillin solution in the place of drinking water, the lactobacilli disappeared, and the yeast from the secreting epithelium colonized the nonsecreting epithelium within 24 hr. The yeast remained in layers on the nonsecreting, as well as the secreting epithelium, as long as penicillin was administered. There is no inflammatory reaction or any sign that the yeast invaded below the keratin layer. When the penicillin treatment was discontinued, within 5 to 8 days the indigenous lactobacilli again colonized the nonsecreting epithelium. Concomitantly the yeast was displaced from the keratinized tissue and once more could be found only on the secreting epithelium. Only 2 days were required, however, for the bacteria to recolonize the keratin layer and displace the yeast when the mice were given indigenous lactobacilli in pure culture immediately after the penicillin treatment was discontinued. The lactobacilli must displace the yeast from the nonsecreting epithelium by interfering either with multiplication of the yeast on the tissue or with attachment of the yeast cells to the keratin layer. This interference must proceed continuously during normal life since the yeast never populates the nonsecreting epithelium as long as the lactobacilli are present.

Effects of neomycin and penicillin administration on mucosal proliferation of the mouse small intestine. With morphological and functional correlations

The effects of an oral neomycin and penicillin regimen on intestinal bacteriology and on morphology and function of the small intestine of mice were investigated. Quantitative and qualitative stool cultures on selective media of the treated animals revealed only growth of yeast organisms. The treated animals developed enlargement of the ceca with fluid contents and watery stools, resembling characteristics of germfree animals. Radioautography with tritiated thymidine revealed an increased epithelial cell migration rate in the mice treated with the antibiotics for 3 to 5 wk. A slight increase in villus height was also noted. The treated male mice showed greater variance than the treated females in epithelial cell migration rates. Histochemical staining reactions showed a decrease in nonspecific esterase and in NADH dehydrogenase activity in the proximal gut of the antibiotic animals. Stains of distal gut and those for acid and alkaline phosphatase, NADPH dehydrogenase, lactic dehydrogenase, and succinic dehydrogenase were similar to the controls. A slight increase in sucrase activity and a slight decrease in lactase activity in the antibiotic animals was observed in contrast to control animals. Germfree mice, however, had greater sucrase and lactase activity. Transport of L-methionine was slightly reduced in the distal segment of the treated animals. Since the direction of these changes is away from the intestinal state observed in germfree animals, they are probably the result of the direct action of the antibiotics on the gut.

Alterations in the mouse cecum and its flora produced by antibacterial drugs

Addition of penicillin, Terramycin, or kanamycin to the drinking water of adult mice rapidly induced in them an enlargement of the cecum. In all animals, this occurred within 12 hr after the beginning of drug administration-the effect being most pronounced with penicillin. The cecums remained enlarged and generally continued to increase in size as long as the antibacterial drugs were administered. The increase in wet weight of the cecums was due primarily to an accumulation of water in the lumens during the first 24-48 hr of drug administration. At that time, there were no detectable histological changes in any case, but the bacteriological picture differed from drug to drug. The cecums were free of bacteria in animals receiving penicillin, fusiform-shaped bacteria and bacteroides were present in those receiving Terramycin, and lactobacilli and bacteroides in those receiving kanamycin. After the initial 48 hr, an abundant and complex secondary microflora developed in all treated animals, its composition being characteristic for each type of antibacterial drug. When penicillin was administered for 2 wk, the cecal weights and microbial populations did not return to normal levels for over 14 days after discontinuance of the drug. This recovery period could be shortened to 10 days by giving the mice food contaminated with cecal homogenates prepared from normal animals. A period of 7 or 8 days was required for the cecal weights and microflora to reach normal levels when the administration of penicillin lasted only 24 hr; this period could not be shortened by giving the animals contaminated food. The effects of drugs on the size and bacterial contents of the cecum have been discussed in the light of earlier findings concerning the characteristics of the huge cecums uniformly found in germfree mice. Taken together, these observations support the hypothesis that certain elements of the intestinal microflora-not yet completely identified-play an essential role in maintaining the integrity of the water-transport mechanism in the intestinal epithelium.