Probiotics co-administered with antibiotics?

[Guest guest]

Hi All, Andrea & Greg,

 

Andrea wrote:

> " Prophylactically, I took a wide-spectrum lactobacillus capsule that

> is enterically-coated, with each dose of antibiotics. "

 

Greg replied:

> I have recently been wondering about this. Is it a good idea to take

> probiotics when taking an antibiotic? Wouldn't the antibiotic be, at

> least in part, " spent " on killing the probiotic bacteria, thus

> reducing the amount of antibiotic remaining to attack the bacteria

> it's meant to be attacking? Anyone have any idea about this?

 

 

SS Biradar, ST Bahagvati, Baburao Shegunshi: Probiotics And Antibiotics: A

Brief Overview. The Internet Journal of Nutrition and Wellness. 2005.

Volume 2 Number 1. says:...

 

Antibiotics are a double edged sword. Their power of fighting infection is

indiscriminate towards all bacteria. All bacteria succumb to their powers, no

mercy is shown towards beneficial strains. One should avoid the use of

antibiotics unless it becomes life threatening. The human immune system

has developed many ways to survive an infection and should be trusted,

nourished, and given time. Our species would not have survived if our

immune system was not the best defense we have against deleterious

infections. If the use of antibiotics becomes absolutely necessary, proceed

with caution. The longer the duration of antibiotic treatment, the more likely a

candida albican infection can occur. Also, the use of probiotics during and

immediately after antibiotic treatment will help minimize the destructive

effects of antibiotics to the beneficial flora. ... During antibiotic therapy,

taking probiotics as well keeps the intestinal flora in proper balance. They

can be taken together, but not at the same time of day. In order for the

probiotics to be the most effective, they should be taken at least two hours

after each dose of antibiotic. When the treatment has been completed,

double or triple the probiotic supplements for about 10-14 days. Probiotics

should be taken with food or shortly after eating as food dilutes the stomach

acids enough for them to survive their trip through to the intestines where

they belong. See the full-text at: http://tinyurl.com/2ot2b5

 

 

However, the jury is still out on the wisdom of co-administration of pro- with

anti- biotics because http://tinyurl.com/2vjl6q says:

 

BC Johnston, AL Supina, M Ospina, S Vohra. Probiotics for the prevention

of pediatric antibiotic-associated diarrhea [Review]. Cochrane Database of

Systematic Reviews 2007 Issue 4. 2007 The Cochrane

Collaboration. Published by John Wiley & Sons, Ltd.

DOI: 10.1002/14651858.CD004827.pub2 This version first published

online: 18 April 2007 in Issue 2, 2007. Date of Most Recent Substantive

Amendment: 24 January 2007

 

This record should be cited as: Johnston BC, Supina AL, Ospina M, Vohra

S. Probiotics for the prevention of pediatric antibiotic-associated diarrhea.

Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.:

CD004827. DOI: 10.1002/14651858.CD004827.pub2.

 

Background: Antibiotics alter the microbial balance within the gastrointestinal

tract. Probiotics may prevent antibiotic-associated diarrhea (AAD) via

restoration of the gut microflora. Antibiotics are prescribed frequently in

children and AAD is common in this population.

 

Objectives: To assess the efficacy and adverse effects of probiotics (any

specified strain or dose) for the prevention of antibiotic-associated diarrhea

in children. To assess adverse events associated with the use of probiotics

when co-administered with antibiotics in children.

 

Search strategy: MEDLINE, EMBASE, CENTRAL, CINAHL , AMED, and the

Web of Science (inception to August 2006) were searched along with

specialized registers including the Cochrane IBD/FBD Review Group,

CISCOM, Chalmers PedCAM Research Register and trial registries from

inception to 2005. Letters were sent to authors of included trials,

nutra/pharmaceutical companies, and experts in the field requesting

additional information on ongoing or unpublished trials. Conference

proceedings, dissertation abstracts, and reference lists from included and

relevant articles were hand searched.

 

Selection criteria: Randomized, parallel, controlled (placebo, active, or no

treatment) trials comparing co-administered probiotics with antibiotics for the

prevention of diarrhea secondary to antibiotic use in children (0 to 18 years).

 

Data collection and analysis: Methodological quality assessment and data

extraction were conducted independently by two authors (BCJ, AS).

Dichotomous data (incidence of diarrhea, adverse events) were combined

using pooled relative risks, and continuous data (mean duration of diarrhea,

mean daily stool frequency) as weighted mean differences, along with their

corresponding 95% confidence intervals. Adverse events were summarized

using risk difference. For overall pooled results on the incidence of diarrhea,

a priori sensitivity analyses included per protocol versus intention to treat,

random versus fixed effects, and methodological quality criterion. Subgroup

analysis were conducted on probiotic strain, dose, definition of antibiotic-

associated diarrhea, and antibiotic agent.

 

Main results: 10 studies met the inclusion criteria. Trials included treatment

with either Lactobacilli spp., Bifidobacterium spp., Streptococcus spp., or

Saccharomyces boulardii alone or in combination. Six studies used a single

strain probiotic agent and four combined two probiotic strains.

 

The per protocol analysis for 9/10 trials reporting on the incidence of

diarrhea show statistically significant results favouring probiotics over

active/non active controls (RR 0.49; 95% CI 0.32 to 0.74). However,

intention to treat analysis showed non-significant results overall (RR 0.90;

95% CI 0.50 to 1.63). Five of ten trials monitored for adverse events (n =

647); none reported a serious adverse event.

 

Authors' conclusions: Probiotics show promise for the prevention of pediatric

AAD. While per protocol analysis yields treatment effect estimates that are

both statistically and clinically significant, as does analysis of high quality

studies, the estimate from the intention to treat analysis was not statistically

significant. Future studies should involve probiotic strains and doses with the

most promising evidence (e.g., Lactobacillus GG, Lactobacillus sporogenes,

Saccharomyces boulardii at 5 to 40 billion colony forming units/day).

Research done to date does not permit determination of the effect of age

(e.g., infant versus older children) or antibiotic duration (e.g., 5 days versus

10 days). Future trials would benefit from a validated primary outcome

measure for antibiotic-associated diarrhea that is sensitive to change and

reflects what treatment effect clinicians, parents, and children consider

important. The current data are promising, but it is premature to routinely

recommend probiotics for the prevention of pediatric AAD.

 

Plain language summary: It is premature to routinely recommend probiotics

for the prevention of pediatric antibiotic-associated diarrhea (AAD)

 

Studies of probiotics for the prevention of pediatric AAD: Ten studies were

reviewed and provide the best evidence we have. Study quality was mostly

good overall. The studies tested 1986 children (aged 0 to 18 years) who

were receiving probiotics co-administered with antibiotics to prevent AAD.

The subjects received probiotics (Lactobacilli spp., Bifidobacterium spp.,

Streptococcus spp., or Saccharomyces boulardii alone or in combination),

placebo (fake pills), other treatments thought to prevent AAD (i.e.

diosmectite or infant formula) or no treatment. The studies were short term

and ranged in length from 15 days to 3 months.

 

What is AAD and could probiotics work to prevent AAD? AAD occurs when

antibiotics disturb the natural balance of " good " and " bad " bacteria in the

intestinal tract causing harmful bacteria to sometimes multiply beyond their

normal numbers. The symptoms of AAD may include frequent watery bowel

movements and crampy abdominal pain. Probiotics are dietary supplements

containing potentially beneficial bacteria or yeast. Probiotics are thought to

restore the natural balance of bacteria in the intestinal tract.

 

What did the studies show? An analysis that included only patients who

completed the studies showed that probiotics may be effective for preventing

AAD. However, a more conservative analysis that counted study drop-outs

as treatment failures did not show any differences between probiotic and

comparison groups.

 

How safe are probiotics? Probiotics were generally well tolerated and side

effects occurred infrequently.

 

What is the bottom line? Although current data are promising, there is

insufficient evidence to routinely recommend the use of probiotics for the

prevention of pediatric AAD.

 

Best regards,

 

[Guest guest]

Thanks to everyone who replied to this thread. Recently a friend of

mine has sent me some information on this subject that matches what

others have said here, so it seems as if the majority are in favor of

this routine.

 

Now for one other question. Dr Tice, I believe, said it's best to take

the probiotics with food, which seems to make sense to me, yet I've

read elsewhere that they should be taken on an empty stomach. Can

anyone speak to this seemingly important point?

 

Thanks!

 

Greg