Antibiotics meet probiotics

In the intricate ecosystem of a healthy bowel, a diverse array of bacteria coexists, with the majority playing harmless or even beneficial roles. This delicate balance is crucial for the bowel’s proper functioning and overall health. However, this equilibrium can be significantly disrupted when a person undergoes antibiotic treatment.

Antibiotics, while essential for combating infections, can be indiscriminate in their actions, killing off large numbers of both harmful and beneficial bacteria in the bowel. This disturbance can upset the natural balance among various bacterial species, leading to a potential overgrowth of aggressive bacteria that were previously kept in check.

What is antibiotic-associated diarrhoea (AAD)?      

Among the troublesome bacteria, Clostridium difficile (C. difficile) stands out. This bacterium can take advantage of the altered environment, proliferating rapidly and producing irritating chemicals. This, in turn, damages the bowel wall, triggering inflammation known as colitis. The manifestations of C. difficile-associated colitis include abdominal pain, cramps, diarrhoea and fever. In severe cases, the diarrhoea can be so voluminous that it leads to dehydration due to a significant loss of body water.

A more serious complication arises when C. difficile overgrowth progresses to pseudomembranous colitis. This condition puts patients at risk of a distended colon that ceases to function properly, known as toxic megacolon. In extreme situations, this can even result in a hole through the bowel wall, known as bowel perforation.

It’s worth noting that C. difficile is present in the bowels of about 5% of people without causing harm. However, antibiotic treatment can inadvertently tip the balance, leading to the overgrowth of C. difficile and subsequent illness. Antibiotic-associated diarrhoea occurs in 2–15% of people taking antibiotics.

Can probiotics reduce the risk?

Probiotics are living microorganisms, including bacteria and yeast, believed to contribute positively to human health. They have gained significant attention as a means to maintain bodily balance.  Despite this, the most robust evidence supports the contention that the most useful effect of probiotics is not gut balance, but is in addressing antibiotic-associated diarrhoea.

A study in the Journal of the American Medical Association explored the impact of probiotics on antibiotic-associated diarrhoea. A team of researchers in California went through the results of 63 trials, pitting probiotics against placebos. About 12,000 people on antibiotics were part of the sample space. The ones who paired up antibiotics with probiotics were 42% less likely to get hit with the dreaded diarrhoea compared to the placebo group.

The idea behind using probiotics is that they may help populations of good bacteria recover more quickly and restore order to the intestines. While the outcomes of this study may seem promising, they may not work for everyone. They may benefit patients, such as:

  • Individuals who have experienced antibiotic-associated diarrhoea before, particularly those with a history of C. difficile infection.
  • Those requiring antibiotics for more than 10 days (some doctors might consider more than 5 days).
  • Individuals who have recently switched from one antibiotic to another in a relatively short timeframe.

There are, however, crucial questions that the researchers couldn’t address:

  • Which probiotics are most effective in preventing and treating antibiotic-associated diarrhoea?
  • Which antibiotics are more prone to causing diarrhoea?

The optimal way to steer clear of antibiotic-associated diarrhoea is by judiciously limiting antibiotic use. For instance, antibiotics might not be necessary for uncomplicated ear or sinus infections or bronchitis, often caused by viruses that antibiotics can’t combat. The key to maintaining a balanced normal flora is to reserve antibiotics for situations where they are truly necessary.

If you are interested in holistic solutions (including product recommendations) for your gut health concerns, our resident Naturopath, Rochelle, can assist you. If you’d like to schedule an appointment with Rochelle, you can conveniently book online. We’re here to support you on your wellness journey.  Our pharmacy staff are also knowledgeable, and can also assist you.

Opinions or facts expressed within the content have been sourced from various news sources. While every effort has been taken to source them accurately, the pharmacy, its owners, staff or other affiliates do not take any responsibility for errors in these sources. Patients should not rely on the facts or opinions in the content to manage their own health, and should seek the advice of an appropriate medical professional. Further, the opinions or facts in the content do not reflect the opinions and beliefs of the pharmacy, its owners, staff or other affiliates. 

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