From the Guidelines
To maintain gut flora balance while taking antibiotics, take a high-quality probiotic supplement containing Saccharomyces boulardii, or the 2-strain combination of Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R, or the 3-strain combination of Lactobacillus acidophilus, Lactobacillus delbrueckii subsp bulgaricus, and Bifidobacterium bifidum, or the 4-strain combination of Lactobacillus acidophilus, Lactobacillus delbrueckii subsp bulgaricus, Bifidobacterium bifidum, and Streptococcus salivarius subsp thermophilus, as suggested by the American Gastroenterological Association (AGA) 1. When taking antibiotics, it is essential to take the probiotic at least 2 hours before or after your antibiotic dose to prevent the antibiotic from killing the beneficial bacteria. Some key points to consider:
- The probiotic should be taken during the entire course of antibiotics and for 1-2 weeks afterward to help restore the gut microbiome.
- Incorporating fermented foods like yogurt with live cultures, kefir, sauerkraut, or kimchi into your diet can also help maintain gut flora balance.
- Prebiotics such as fiber-rich foods (fruits, vegetables, whole grains) can help feed the beneficial bacteria.
- The use of probiotics in preventing antibiotic-associated C difficile infection has been shown to be beneficial, particularly in patients with high risk of developing C difficile infection 1.
- However, the overall certainty of the evidence is low due to unclear or high risk of bias in most of the trials across all domains for all outcomes assessed 1.
- Patients who place a high value on avoiding associated financial cost or potential harms, especially those with severe illnesses, may choose not to use probiotics 1. It is crucial to weigh the potential benefits and harms of probiotic use, especially in vulnerable populations, and consider the risk-benefit ratio before prescribing probiotics 1. Additionally, the safety of probiotics has been evaluated in several studies, and while most probiotics are considered safe for the general population, careful evaluation is required in vulnerable groups, such as patients with damaged intestinal mucosa or immune dysregulation 1.
From the Research
Probiotic Regimen for Maintaining Gut Flora Balance
When taking antibiotics, it is essential to maintain gut flora balance to prevent antibiotic-associated diarrhea and other gastrointestinal side effects. The following points summarize the recommended probiotic regimen:
- Probiotic Species: The most-studied species for maintaining gut flora balance include Lactobacillus, Bifidobacterium, and Saccharomyces 2, 3.
- Probiotic Dosage: A probiotic should typically contain several billion microorganisms to increase the chance that adequate gut colonization will occur 3.
- Probiotic Strains: Specific strains such as Lactobacillus acidophilus, Lactobacillus paracasei, Bifidobacterium lactis, and Bifidobacterium bifidum have been shown to be effective in altering the gastrointestinal microbiota during antibiotic treatment 4.
- Timing of Probiotic Intake: Bacteria-derived probiotics should be separated from antibiotics by at least two hours 3.
- Duration of Therapy: The duration of probiotic therapy depends on the clinical indication, but studies have shown that taking probiotics for 4 weeks can be effective in reducing the duration of antibiotic-associated diarrhea 4.
- Benefits of Probiotics: Probiotics have been shown to reduce antibiotic-induced gastrointestinal side effects, prevent antibiotic-associated diarrhea, and maintain gut microbial composition 5, 6.
Key Findings
Some key findings from the studies include:
- Probiotic co-administration with antibiotics can prevent some of the gut microbial diversity and composition changes induced by antibiotics 6.
- Probiotics can restore health-related bacteria such as Faecalibacterium prausnitzii 6.
- The addition of probiotics to antibiotic interventions can preserve alpha diversity and ameliorate the changes to gut microbial composition caused by antibiotic interventions 6.