Health & Fitness
On an Antibiotic? A Probiotic a Day May Keep the Bad Bugs Away
It is important to maintain a healthy balance of the "good bacteria" vs. the "bad bacteria" in the small and large intestine. Probiotics help maintain this balance.
My patients who have received an antibiotic from me at Greentree Pharmacy know well that with every antibiotic, I recommend a probiotic. This is one of my standard recommendations that I counsel patients about when I am discussing the antibiotic therapy.
There are a multitude of different live “good” bacteria in the small and large intestine. This bacteria is referred to as microflora, and it is important to maintain a healthy balance of the “good bacteria” vs. the “bad bacteria” in the microflora.
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So what do antibiotics do? They kill bacteria right? Right – so during antibiotic therapy, the delicate balance of gut microflora is disrupted, as high numbers of the "good bacteria" are killed off, allowing the “bad bacteria” to take over.
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The flora in a healthy small intestine is dominated by Lactobacilli and the flora in a healthy large intestine by Bifidobacteria. When the good bacteria no longer dominates, “bad bacteria” or pathogenic bacteria can overgrow, causing many problems - including diarrhea - the most common side effect of antibiotic therapy. More severe situations of this overgrowth of “bad bacteria” can occur resulting in a “super infection” of the gut. Typically this results in severe, prolonged diarrhea, which can be fatal, particularly if overgrowth of Clostridium difficile is the reason. This complication of antibiotic-associated diarrhea (AAD) occurs in 5% to 39% of patients receiving antibiotics, and about 20% of AAD is Clostridium difficile–associated diarrhea (CDAD). The median onset of diarrhea is 5 to 9 days after starting antibiotic therapy, although AAD can be delayed up to several weeks.
What can you do to prevent this?
By taking a high quality and high potency probiotic, an imbalance in the gut microflora can be prevented. I always recommend to my patients that he or she start on a probiotic at the same time as starting the antibiotic. I recommend continuing the probiotic for one full month. Take the probiotic once daily, at least one hour prior to the first dose of the antibiotic each day. This separation in time of taking the probiotic and antibiotic is very important, because the antibiotic may kill off the probiotic not allowing it to do its job.
If you did not take a probiotic during antibiotic therapy, you should definitely consider taking a probiotic after therapy to re-establish the balance.
Many ask if eating yogurt while taking antibiotics will suffice to maintain the normal flora. However, this simply is not enough. Yogurts that are labeled with "live cultures" are the ones that contain viable probiotics, but according to several independent clinical trials, you will need billions more live cultures to re-establish the balance of gut bacteria.
Probiotics are generally well tolerated with only mild gastrointestinal adverse effects. However, more serious, but rare adverse effects have been reported. Caution is advised for probiotic use in patients who are immunocompromised and those who have cardiac valve disease.
Many clinical trials have demonstrated probiotic use prevents antibiotic-associated diarrhea. Annals of Internal Medicine published a review and meta-analysis in December 2012 which included adults and children who were taking antibiotics, and concluded that preventative use of probiotics was associated with a 66% reduced risk of developing Clostridium difficile-associated diarrhea with no increase in side effects, compared with placebo or no treatment.
The American Academy of Pediatrics considers evidence to be reasonable for use of probiotics to limit AAD in children.
Although more research is needed, there's encouraging evidence that probiotics may also help:
- Prevent and treat vaginal yeast infections and urinary tract infections
- Treat irritable bowel syndrome
- Reduce bladder cancer recurrence
- Speed treatment of certain intestinal infections
- Prevent and treat eczema in children
- Prevent or reduce the severity of colds and flu
The most studied probiotic agents for AAD are lactobacilli, particularly Lactobacillus GG, Saccharomyces boulardii, and probiotic mixtures. No specific probiotic dose has been identified as efficacious for AAD; however, 107 to 1010 colony-forming units (CFUs) per dose or 108 to 1010 CFUs daily is the minimum for efficacy across a wide range of indications.
My #1 recommended probiotic is Ortho Biotic and for children, Floraboost by Ortho Molecular Products. Ortho Biotic and Floraboost contain a blend of 6 strains of Lactobacilli and Bifidobacteria at high amounts and also includes Saccharomyces Boulardii which is rich in mannose, helping it to adhere to bad bacteria. In addition, these products do not require refrigeration.
Best In Health,
Paul Hueseman, PharmD