Coadministration of Probiotics With Antibiotics

Why, When and for How Long?

Lyudmila Boyanova; Ivan Mitov

Disclosures

Expert Rev Anti Infect Ther. 2012;10(4):407-409. 

In This Article

Antibiotic-associated Diarrhea & Clostridium difficile-associated Diarrhea

Diarrhea occurs in 5–39% of patients treated by antibiotics.[9] Clostridium difficile -associated diarrhea (CDAD) encompasses 10–25% of antibiotic-associated diarrhea (AAD) cases, and hypervirulent C. difficile strain (ribotype 027) additionally increases the severity of the disease.[10]Clostridium perfringens, Bacteroides fragilis, Klebsiella oxytoca, Staphylococcus aureus and fungi can also cause AAD. Clindamycin, cephalosporins and, recently, fluoroquinolones are associated with highest risk for CDAD. Other at-risk patients are elderly subjects, hospitalized and oncologic patients, and users of proton-pump inhibitors. Importantly, the probiotic use can decrease the risk of AAD by >50% but should start within 72 h of the onset of antibiotic therapy.[11]

Use of probiotics can be recommended for prophylaxis of AAD and CDAD in patients treated by broad-spectrum antibiotics, especially in high-risk antibiotic recipients. For this purpose, L. rhamnosus GG and S. boulardii are used, the latter inhibiting C. difficile toxin effects.[9] Mixture, including L. acidophilus CL1285 or fermented milk of L. casei DN-114001,Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus can also diminish the risk of AAD and CDAD.[11]L. delbrueckii spp. bulgaricus B-30892 shows promising in vitro results.[12] Coadministration of S. boulardii, L. rhamnosus GG, Lactobacillus plantarum 299v, L. acidophilus and Bifidobacterium bifidum and oral metronidazole or vancomycin has been reported in CDAD treatment.[12] Notably, not all strains of a species provide the expected activity.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....