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

H. pylori eradication

H. pylori eradication often fails due to antibiotic resistance or adverse effects of therapy.[3]Lactobacillus spp. exhibit anti-H. pylori activity in vitro, inhibiting H. pylori urease activity and adhesion, secreting short-chain fatty acids, bacteriocins/bacteriocin-like substances and acting as immunomodulators.[3] Adding probiotics to regimens reduces side effects by 11–23% and may slightly improve eradication rates by ≤ 5–15%.[3,13] The so-far most-active Lactobacillus strains are L.casei and Lactobacillus johnsonii La1.[13] Although it is controversial whether the probiotics reduce development of antibiotic resistance in the intestinal microflora, in two studies, ingestion of probiotics (L. acidophilus and Bifidobacterium strains or cheese) was found to reduce the emergence of resistant enterococci.[14,15] Activity of the lactobacilli is species and strain specific. Probiotic mixtures should be considered carefully as the proinflammatory activity of one probiotic can mask the anti-inflammatory effect of the others.[16] Another treatment adjunct is S. boulardii, which is immunomodulatory and inhibits bacterial adhesion and toxins.[3] According to Szajewska et al.,[17] S. boulardii supplementation on triple regimens improves the treatment success by 9% and diminishes adverse effects of therapy by 11.4%, especially diarrhea. Briefly, probiotics reduce the side effects of H. pylori regimens and may slightly increase eradication success.

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