Coadministration of Probiotics With Antibiotics

Why, When and for How Long?

Lyudmila Boyanova; Ivan Mitov


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.


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