From the Research
Lactobacillus supplementation is generally not recommended during meropenem treatment. While meropenem, a broad-spectrum carbapenem antibiotic, can disrupt normal gut flora and potentially lead to antibiotic-associated diarrhea or Clostridioides difficile infection, concurrent probiotic administration has not been conclusively proven beneficial and may pose risks 1. The primary concern is that immunocompromised patients receiving meropenem might be vulnerable to probiotic-associated infections, including rare cases of Lactobacillus bacteremia. Additionally, there's limited evidence that probiotics effectively prevent antibiotic-associated complications when administered alongside carbapenems specifically.
Some key points to consider:
- Meropenem has a broad spectrum of activity against gram-negative, gram-positive, and anaerobic bacteria, making it a effective treatment option for various infections 2, 3.
- The use of meropenem as empirical monotherapy has been shown to be effective in treating serious infections, including those in intensive care units 4.
- However, the use of probiotics, such as Lactobacillus, during meropenem treatment is not supported by strong evidence, and may pose risks to immunocompromised patients 1.
- A better approach is to use meropenem judiciously (typically 1 gram IV every 8 hours for adults with normal renal function, adjusted for specific infections and patient factors) and consider Lactobacillus or other probiotics only after completing the antibiotic course if gastrointestinal symptoms develop. This sequential rather than concurrent administration minimizes potential risks while still addressing antibiotic-associated gut flora disruption if it occurs.
It's worth noting that the most recent and highest quality study 1 does not support the use of Lactobacillus supplementation during meropenem treatment, and therefore this approach should be avoided. Instead, meropenem should be used judiciously and probiotics considered only after completing the antibiotic course if necessary.