Administration of Lactobacillus acidophilus and Bifidobacterium
Lactobacillus acidophilus and Bifidobacterium should be administered orally at doses ranging from 1 × 10⁹ to 1 × 10¹¹ CFU per day, typically divided into 1-3 doses daily, and can be given via capsules, sachets, or through enteral feeding tubes when oral administration is not feasible. 1, 2
Route of Administration
Oral Administration (Preferred)
- Capsules or sachets are the standard delivery method for ambulatory patients 1
- Administer with or without food, though some formulations may specify timing 2
- For patients with swallowing difficulties, capsules can be opened and mixed with small amounts of water or non-acidic beverages 3
Enteral Tube Administration
- Nasogastric (NG) or nasojejunal (NJ) tubes can be used in critically ill or hospitalized patients 1
- Crush capsules or dissolve powder formulations in 20-50 mL of water before administration through feeding tubes 1
- Flush tube with 30 mL water after probiotic administration to ensure complete delivery 1
Oropharyngeal Administration
- In mechanically ventilated patients, probiotics can be administered as oral care using liquid formulations (80 mL containing 8 × 10⁹ CFU) after standard oral hygiene 1
- This route may be combined with enteral administration for enhanced effect 1
Dosing Guidelines
Standard Adult Dosing
- Lactobacillus acidophilus: 1 × 10¹⁰ CFU daily is effective for IBS and functional bowel disorders 2, 4
- Bifidobacterium lactis: 1.8-17.2 billion CFU daily, with higher doses (17.2 billion) showing superior efficacy for transit time 5
- Combination therapy: 2 × 10¹¹ CFU/day total (divided twice daily) when using both strains together 4
Critical Illness Dosing
- Higher doses are used in critically ill patients: 2.5 × 10⁹ to 4 × 10¹¹ CFU per day 1, 6
- Administer 2-4 times daily through enteral feeding tubes 1
- Duration typically ranges from 7-28 days depending on clinical indication 1
Pediatric and Preterm Infant Dosing
- Preterm infants: Combination of Lactobacillus and Bifidobacterium species at doses appropriate for weight (typically 10⁷-10⁹ CFU/day) 1
- Administer once or twice daily, mixed with breast milk or formula 1
Duration of Treatment
Acute Conditions
- Antibiotic-associated diarrhea prevention: Continue throughout antibiotic course and for 5-7 days after completion 1
- Acute gastroenteritis: 5-7 days of treatment 1
Chronic Conditions
- IBS and functional bowel disorders: Minimum 4-6 weeks, with assessment at 12 weeks 1, 2
- Constipation: 14 days minimum, with effects potentially lasting longer 5
- Discontinue if no improvement after 12 weeks 1
Timing and Frequency
Daily Administration Schedule
- Once daily: Acceptable for most maintenance therapy 1, 5
- Twice daily (BID): Preferred for acute symptoms and IBS management 1, 2, 4
- Three times daily (TID): Used in some critical illness protocols 1
Optimal Timing
- Can be taken with or between meals 2
- For patients on antibiotics, separate probiotic administration by 2-3 hours from antibiotic doses to minimize bacterial killing 1
Storage and Viability Considerations
- Most formulations require refrigeration to maintain viability, though some shelf-stable products exist 3
- Verify product contains viable organisms (check expiration dates and CFU counts) 1
- Avoid exposure to extreme heat (>37°C/98.6°F) which reduces bacterial survival 7, 3
Important Clinical Caveats
Contraindications
- Immunocompromised patients: Probiotics are contraindicated due to bacteremia risk 6
- Central venous catheters: Avoid in patients with indwelling lines who are severely debilitated 1
- Severe acute pancreatitis: Some evidence suggests harm; use with extreme caution 1
Combination Therapy
- Multi-strain formulations may be more effective than single strains for certain conditions 1, 6
- Lactobacillus acidophilus combined with Bifidobacterium species shows enhanced efficacy for IBS 1, 2
- Avoid mixing different probiotic products simultaneously unless specifically studied together 1