Would you discuss how you determine duration of antimicrobial treatments for dysbiosis? Specifically interested in pediatrics and I’m not sure where to start with children but also have trouble deciding on duration for adults.

Chris Kresser:  Well, in general, with pediatrics as a rule, shorter durations are typically more appropriate. Because I find that they tend to respond more quickly and the precautionary principle also applies. So with kids, I would be likely to start with a lower dose, maybe two weeks, and just retest after two weeks to see what happens. I retest more sooner and more frequently with kids because I want to see if what we did worked, and if it did, I don’t want them to be unnecessarily taking antimicrobials, even botanicals, given their stage of development. With adults, it depends on what the dysbiosis is. If it’s insufficiency dysbiosis, I might not do an antimicrobial protocol at all, as you know. If it’s pathogenic dysbiosis and it’s relatively mild, I’d probably start with 30 days and then retest. But if it’s more severe I might do 60 to 90 days before retesting. It also depends somewhat on their history with these protocols. If they’ve done other protocols and they haven’t had a lot of success, then I might do a longer protocol. If they’re completely new to these protocols, I might do a shorter one. Severity does affect my approach with pediatrics too. If they have really severe issues in the gut and they have a lot of behavioral issues, mood issues as well, I might do the protocol for a little bit longer and observe symptoms. Have the parents observe symptoms in addition to just a general consideration about when to retest.