Bouncing Back After Antibiotics with Probiotics
If you own a human body, chances are you’ve taken at least one course of antibiotics in your lifetime – whether it was bubble-gum flavored amoxicillin for that ear infection in childhood, penicillin for the case of strep throat that roared through the school, or a ceftriaxone shot after a rowdy weekend in Vegas.
As clearly helpful (and sometimes life-saving) antibiotic medications can be, they are not without their risks. In fact, antibiotics can even cause health problems in both the short and long term.
The potential harm in using antibiotics
Antibiotic prescription is the standard of care for various bacterial infections affecting virtually any site in the body, and for good reason: these drugs have saved millions of lives. But they are not without risks of side effects. As the name anti-biotic implies, these medications kill bacteria. Although bacteria-killing can be quite helpful, say, in the case of killing the E. coli that’s causing a urinary tract infection that can can crawl up into the kidneys and wreak havoc there if not stopped, antibiotic medications are not particularly discerning in what strains they kill, or where. By their very nature, antibiotics disrupt the microbial milieu of the digestive tract and other body systems, killing the good, or helpful, strains of bacteria along with the bad.
The shift in bacterial balance caused by antibiotic drugs predisposes antibiotic users to dysbiosis, or a microbial imbalance, leaving them at increased risk of side effects, particularly in the gastrointestinal tract where a large percentage of these commensal organisms are found. Reduced microbial diversity can also encourage the growth of opportunistic pathogens such as Clostridicum difficile (aka “C-diff”), a potentially life-threatening condition,[i] as well as a decline in the immune system’s ability to fight off infections in various sites of the body. Alterations to the normal microbial milieu is why many people notice diarrhea or other digestive complaints after taking an antibiotic, and why women often develop vaginal yeast infections after a course of treatment. In the longer haul, decreased microbial diversity is also implicated in obesity,[ii] atopic conditions like eczema, asthma, and allergies,[iii],[iv],[v],[vi] and even mood imbalances like anxiety and depression.[vii]
Bacteria can also mutate and adapt over time to outsmart the drugs we use to treat them. This has resulted in antibiotic-resistant infections, or “superbugs,” which has the medical community wondering: what will we do when the antibiotics available to us stop working?
Both conventional and alternative-minded practitioners agree that we need to be more discerning of when antibiotics are – and are not – truly necessary in the treatment of infections,[viii],[ix] yet despite this awareness the Center for Disease Control (CDC) estimates that 30% of all antibiotic prescriptions in the US are unnecessary.[x]
But in those cases when antibiotics are used, there are thankfully other therapies we can employ to both increase the infection-fighting efficacy of the antibiotic and to minimize its potentially harmful side effects. Specifically: probiotics.
A high-potency probiotic during/after antibiotic use can make all the difference
Supplementing with a carefully selected probiotic formula during, after, and potentially in lieu of conventional treatment may not only help treat infectious illnesses more effectively, but may also reduce the risk of their recurrence.
Because of their efficacy in countering dysbiosis,[xi] probiotics – in particular strains of Lactobacillus and Bifidobacterium species[xii] – have been shown to effectively treat not only acute infectious diarrhea,[xiii] but also antibiotic-associated diarrhea,[xiv],[xv],[xvi] including even C. difficile infection.[xvii] In fact, over a decade’s worth of meta-analyses have shown that probiotics can reduce the incidence of antibiotic-associated diarrhea by 42-50%,[xviii],[xix],[xx] making the case for probiotic supplementation around antibiotic use quite compelling.
While probiotics are clearly useful in reducing the side effects of antibiotic use, it’s important to note that not all strains are created equal and that higher doses of probiotics confer better outcomes than lower doses.[xxi] Some of the probiotic strains shown in the studies to be of benefit include Lactobacillus rhamnosus, L. casei, L. acidophilus, L. reuteri, L. plantarum, Bifidobacterium lactis, B. infantis, B. longum, Saccharomyces boulardii, and Bacillus coagulans,at potencies of 100 million to 50 billion colony forming units (CFUs) per day in adults. In the studies done on children, doses over 5 billion CFUs per day yielded better outcomes than lower doses.[xxii]
Lactobacilli make up over 90% of the microbes present in the female genitourinary system and these bacteria are extremely sensitive to destruction by antibiotic medications, leaving women susceptible to rebound vaginal, urinary, and reproductive infections. It’s pretty clear that most women would be benefitted by taking a probiotic supplement before, during, and after using antibiotic medications.
Numerous trials have demonstrated that oral administration of specific strains of lactobacilli – in particular L. acidophilus, L. crispatus, L. rhamnosus, L. gasseri and L. reuteri – can both maintain and restore healthy genitourinary microbiota in females.[xxiii],[xxiv],[xxv] Oral probiotics may be a side-effect-free standalone treatment for vaginitis, saving women from having to use antibiotics at all.[xxvi]
The addition of a probiotic supplement to the standard treatment regimens for bacterial vaginosis, yeast infections, and other causes of infectious vaginitis has been shown in several studies to not only improve the initial success of treatment, but also to support healthy vaginal microflora after antibiotic use and reduce the risk of future relapses of vaginitis.[xxiv], [xxv],[xxvii], [xxviii], [xxix], [xxx]
Regardless of the site of infection or the reason for antibiotic use, the argument for using probiotics in conjunction with antibiotics is strong. By minimizing the disruption to the microbial balance caused by antibiotics, a high quality, multi-strain probiotic supplement makes antibiotic-based treatments more successful in fighting off infections, dampens the side effects and long-term consequences of taking antibiotic medications, and significantly reduces the risk of infection relapse. The benefits of using probiotics as an adjuvant to antibiotic prescription are clear.
[i] Schäffler H, et al. Clostridium difficile – From colonization to infection. Front Microbiol. 2018 Apr 10;9:646.
[ii] Turnbaugh PJ, et al. A core gut microbiome in obese and lean twins. Nature. 2009 Jan 22;457(7228):480-4.
[iii] Kalliomäki M, et al. Probiotics in primary prevention of atopic disease: a randomised placebo-controlled trial. Lancet. 2001 Apr 7;357(9262):1076-9.
[iv] Zhao M, et al. Treatment efficacy of probiotics on atopic dermatitis, zooming in on infants: a systematic review and meta-analysis. Int J Dermatol. 2018 Feb 8.
[v] Hoang BX, et al. Lactobacillus rhamnosus cell lysate in the management of resistant childhood atopic eczema. Inflamm Allergy Drug Targets. 2010 Jul;9(3):192-6.
[vi] Butel M-J, et al. The developing gut microbiota and its consequences for health. J Dev Orig Hlth Dis. 2018:1-8.
[vii] Luna RA, et al. Gut brain axis: diet microbiota interactions and implications for modulation of anxiety and depression. Curr Opin Biotechnol. 2015 Apr;32:35-41.
[viii] Roca I, et al. The global threat of antimicrobial resistance: science for intervention. New Microbes New Infect. 2015 Apr 16;6:22-9.
[ix] Davey P, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database of Systematic Reviews 2013; 4: CD003543.
[x] Fleming-Dutra KE, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA: The Journal of the American Medical Association 2016; 315(17): 1864-73.
[xi] McFarland LV. Use of probiotics to correct dysbiosis of normal microbiota following disease or disruptive events: a systematic review. BMJ Open. 2014;4, e005047.
[xii] Lievin-Le Moal V, Servin AL. Anti-infective activities of lactobacillus strains in the human intestinal microbiota: from probiotics to gastrointestinal anti-infectious biotherapeutic agents. Clin Microbiol Rev. 2014;27:167–99.
[xiii] Allen SJ, et al. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev. 2010;CD003048.
[xiv] Johnston BC, et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev. 2011;CD004827.
[xv] Videlock EJ, Cremonini F. Meta-analysis: probiotics in antibiotic-associated diarrhoea. Alimentary Pharmacol Therapeut. 2012;35:1355–69.
[xvi] Hempel S, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. JAMA. 2012;307:1959–69.
[xvii] Johnston BC, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea: a systematic review and meta-analysis. Ann Intern Med. 2012;157:878–88.
[xviii] D’Souza AL, et al. Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis. BMJ. 2002 Jun 8;324(7350):1361.
[xix] Sazawal S, et al. Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebo-controlled trials. Lancet Infect Dis. 2006 Jun;6(6):374-82.
[xx] McFarland LV, et al. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol. 2006 Apr;101(4):812-22.
[xxi] Courvalin P. Antibiotic resistance: the pros and cons of probiotics. Dig Liver Dis. 2006 Dec;38 Suppl 2:S261-5.
[xxii] Goldenberg JZ, et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev. 2015 Dec
[xxiii] Strus M, et al. Studies on the effects of probiotic Lactobacillus mixture given orally on vaginal and rectal colonization and on parameters of vaginal health in women with intermediate vaginal flora. Eur J Obstet Gynecol Reprod Biol. 2012 Aug;163(2):210-5.
[xxiv] Reid G, et al. Oral probiotics can resolve urogenital infections. FEMS Immunol Med Microbiol. 2001 Feb;30(1):49-52.
[xxv] Raghuwanshi S, et al. Probiotics: Nutritional Therapeutic Tool. J Prob Health. 2018;6(194):2.
[xxvi] Vujic G, et al. Efficacy of orally applied probiotic capsules for bacterial vaginosis and other vaginal infections: a double-blind, randomized, placebo-controlled study. Eur J Obstet Gynecol Reprod Biol. 2013; 168(1):75-79.
[xxvii] Davar R, et al. Comparing the Recurrence of Vulvovaginal Candidiasis in Patients Undergoing Prophylactic Treatment with Probiotic and Placebo During the 6 Months. Probiotics & Antimicro. Prot. (2016) 8: 130.
[xxviii] Mastromarino P, et al. Bacterial vaginosis: a review on clinical trials with probiotics. New Microbiol. 2013 Jul;36(3):229-38.
[xxix] Hanson L, et al. Probiotics for Treatment and Prevention of Urogenital Infections in Women: A Systematic Review. J Midwifery Womens Health. 2016 May;61(3):339-55.
[xxx] Falagas, et al. Probiotics for prevention of recurrent urinary tract infections in women: a review of the evidence from microbiological and clinical studies. Drugs. 2006;66(9):1253-61.
A similar version of this article first appeared in June 2018 at Allergy Research Group.