Effect of Adding Probiotics to Antibiotic Regimens - EMJ

Does Adding Probiotics to Antibiotic Regimens Reduce Antibiotic-Induced Gut Microbiome Changes?

2 Mins
Microbiology & Infectious Diseases

USING a probiotic alongside antibiotic treatment has been shown to prevent some of the antimicrobial-induced gut microbiome changes associated with antibiotic use, according to the results of a systematic review conducted by lead author Melissa Fernández-Alonso, Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Nuevo León, Mexico, and colleagues. 

Given that antibiotics are not selective in targeting pathogens and as a result cause death of commensal bacterial flora, which plays an important role in health, the authors of this study aimed to evaluate whether using a probiotic alongside antibiotics could act to prevent or reverse the antibiotic-induced antimicrobial effects to the gut microbiome. 

Using several databases, and following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two members of the team conducted a search that included the terms “randomised clinical trials assessing the effect of antibiotics, probiotics, or antibiotics+probiotics,” “16S rRNA,” “adult participants,” and “in English.” The data was analysed and merged by a third researcher and the risk of bias was analysed using the National Institutes of Health (NIH) rating system. In total, 29 articles were included in the review, of which seven assessed antibiotics plus probiotics, 11 studied probiotics alone, and the remaining 11 evaluated antibiotics alone. 

The results showed that using a probiotic alongside antibiotic treatment led to the prevention of some antibiotic-induced changes to gut microbial composition but did not prevent all changes. In addition to this, combining the antibiotic with a probiotic helped to restore some natural commensals vital to gut health. Co-author Elisa Marroquin, Texas Christian University, USA, highlighted that several consistent changes to bacterial species in the gut microbiome occur in participants taking antibiotics, but in combination with probiotics, “the majority of those changes were less pronounced, and some changes completely prevented.” 

From the findings, Marroquin stated: “Considering the human data available up to this point, there does not seem to be a reason to withhold a prescription of probiotics when antibiotics are prescribed.” However, one of the limitations of this systematic review was the absence of standardisation in protocols analysing the gut microbiome and the wide-ranging antibiotics and probiotics used across the trials, which made data interpretation challenging. Further research is needed as these findings could potentially be useful in reducing antibiotic-induced complications. 

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