Differences Between Lactobacillus rhamnosus and Lactobacillus acidophilus for Probiotic Use
Lactobacillus rhamnosus is more effective for preventing antibiotic-associated diarrhea, Clostridium difficile infection, and necrotizing enterocolitis in preterm infants, while Lactobacillus acidophilus shows greater efficacy in reducing total and LDL cholesterol levels. 1
Clinical Applications and Efficacy
L. rhamnosus
- Most effective for preventing and treating diarrheal conditions, particularly antibiotic-associated diarrhea at doses of >10^9 CFU/day 1
- Recommended for prevention of nosocomial diarrhea in pediatric populations 1
- Demonstrated efficacy in preventing necrotizing enterocolitis in preterm infants, with significant reduction in all-cause mortality (OR 0.56,95% CI 0.39-0.80) 1
- Shows persistence in colonic mucosa after discontinuation of administration, with colonization lasting more than a week 2
- Recently reclassified as Lacticaseibacillus rhamnosus based on DNA analysis showing genetic diversity among Lactobacillus species 1
- Demonstrated safety and efficacy as monotherapy for induction of remission in ulcerative colitis patients with mild-moderate disease activity 3
L. acidophilus
- Superior efficacy in reducing total and LDL cholesterol compared to other Lactobacillus species 1
- Often used in combination with other strains for metabolic conditions 1
- Effective when combined with Bifidobacterium species for prevention of necrotizing enterocolitis in preterm infants 1
- Shows synergistic effects when combined with L. rhamnosus in protecting intestinal membrane integrity during infections 4
Mechanisms of Action
L. rhamnosus
- Enhances intestinal cell production and increases the number of cells in intestinal villi, which may explain its reparative effect on mucosa 5
- Facilitates maintenance of intestinal membrane integrity during infections 4
- Capable of attaching to colonic mucosa in vivo, allowing for temporary but significant colonization 2
L. acidophilus
- More effective in cholesterol metabolism, particularly in reducing total and LDL cholesterol 1
- Works synergistically with L. rhamnosus to protect intestinal membrane integrity by preserving membrane-bound ATPases and tight junction proteins 4
Combination Therapy
- Combination of L. rhamnosus and L. acidophilus provides superior protection against intestinal membrane damage compared to either strain alone during Shigella dysenteriae infection 4
- For prevention of Clostridium difficile infection, a combination of L. acidophilus, L. casei, and L. rhamnosus strains has shown efficacy in reducing incidence rates 6
- Multi-strain combinations including both species are often more effective than single strains for various gastrointestinal conditions 1
Clinical Recommendations
- For antibiotic-associated diarrhea prevention: Choose L. rhamnosus GG at doses >10^9 CFU/day 1
- For cholesterol management: L. acidophilus is the preferred choice 1
- For necrotizing enterocolitis prevention in preterm infants: Use combinations including both L. rhamnosus and L. acidophilus with Bifidobacterium species 1
- For intestinal infections: Consider combination therapy with both strains for synergistic protection of intestinal membrane integrity 4
Important Considerations
- Strain specificity is crucial - effects are strain-specific rather than species-wide 1
- The American Gastroenterological Association recommends specific strains for specific conditions rather than making general recommendations about probiotics 1
- Safety profile is generally excellent for both species, but caution is advised in premature neonates, immunocompromised patients, critically ill patients, and those with central venous catheters, cardiac valvular disease, or short-gut syndrome 1