Written by Angeline A. De Leon, Staff Writer. Both high and low doses of a proprietary blend of Lactobacillus acidophilus, Lactobacillus paracasei Lpc-37, Bifidobacterium lactis BI-07, and Bifidobacterium lactis BI-04) were significantly more effective in lowering the development of antibiotic- associated diarrhea then the placebo in the 503 hospitalized patients requiring antibiotic treatment.
Although critical for the clinical treatment of infectious diseases, the use of antibiotics can also trigger the development of certain gastrointestinal issues, including antibiotic-associated diarrhea (AAD) 1. The prevalence of AAD is dependent not only the clinical environment of the patient, but also the class of antibiotics administered 2. Various lines of research indicate that specific probiotic strains can improve the incidence rates of AAD by up to 57% 3, and may also greatly reduce the risk of a related illness, C. difficile-associated diarrhea (CDAD) 4. To date, limited data exists on the dose-response effect of probiotics for the treatment of AAD. Therefore, in a research study published in Vaccine (2014), investigators designed a dose-response study, looking at the effects of a strain-specific combination of probiotics known to balance intestinal microbiota 5 on AAD- and CDAD-related gastrointestinal symptoms of patients undergoing antibiotic therapy.
A total of 503 hospital patients (aged 30-70 years) requiring antibiotic treatment participated in a triple-blind, randomized, placebo-controlled study.6 Volunteers were randomized into one of three groups: a high-dose group receiving 1.70 x 1010 CFU of HOWARU® Restore probiotic (a proprietary blend containing Lactobacillus acidophilus, Lactobacillus paracasei Lpc-37, Bifidobacterium lactis BI-07, and Bifidobacterium lactis BI-04), a low-dose group receiving 4.17 x 109 CFU of HOWARU® Restore, or placebo. Subjects were stratified by gender, age, and duration of antibiotic treatment. Study product was delivered to patients daily for 10-21 days, depending on length of antibiotic administration (up to 7 days following final antibiotic dose). Patients were monitored for incidence of AAD, CDAD, and symptoms of gastrointestinal disturbance, including diarrhea, abdominal cramping, and bloating.
Results revealed a significant dose-response effect of AAD based on probiotic intake: high-dose = 12.5% incidence rate of AAD; low-dose = 19.6%; placebo = 24.6% (p = 0.02). Incidence of CDAD was highest for placebo (4.8%) and equally lower for the probiotic groups (1.8% for both low- and high-dose, p = 0.04). With increasing probiotic dosage, significant reductions were also observed regarding incidences of fever (p = 0.035), abdominal pain (p < 0.001), bloating (p = 0.029), number of daily liquid stools (p < 0.001), and average duration of diarrhea (p < 0.041).
In sum, findings indicate that the four-strain combination of probiotics used in the present study was not only effective in lowering the risk of AAD, CDAD, and related gastrointestinal symptoms in adult patients undergoing antibiotic therapy, but that it operated in a dose-dependent manner. The use of probiotic strains appears to offer considerable efficacy in reducing the incidence, duration, and severity of AAD and CDAD, however, the targeted effects associated with certain strains deserves further study.
Source: Ouwehand AC, Donglian C, Weigjian X, et al. Probiotics reduce symptoms of antibiotic use in a hospital setting: A randomized dose response study. Vaccine. 2014; 32: 458-463. DOI: 10.1016/j.vaccine.2013.11.053.
© The British Society for Antimicrobial Chemotherapy
Posted October 30, 2017.
Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.
References:
- Wiström J, Norrby SR, Myhre EB, et al. Frequency of antibiotic-associated diarrhoea in 2462 antibiotic-treated hospitalized patients: a prospective study. Journal of antimicrobial chemotherapy. 2001;47(1):43-50.
- McFarland L. Epidemiology, risk factors and treatments for antibiotic-associated diarrhea. Digestive Diseases. 1998;16(5):292-307.
- McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. The American journal of gastroenterology. 2006;101(4):812.
- Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. Jama. 2012;307(18):1959-1969.
- Engelbrektson A, Korzenik JR, Pittler A, et al. Probiotics to minimize the disruption of faecal microbiota in healthy subjects undergoing antibiotic therapy. Journal of medical microbiology. 2009;58(5):663-670.
- Ouwehand AC, DongLian C, Weijian X, et al. Probiotics reduce symptoms of antibiotic use in a hospital setting: a randomized dose response study. Vaccine. 2014;32(4):458-463.
