Ever since the invention of penicillin in the mid-20th century, there has been much talk about the harmful effects of antibiotics on the body. The indications for the use of antibiotics are variable and depend on the site of infection, the pathogenic pathogen as well as the general condition, and the clinical state of the patient. Unfortunately, antibiotics not only affect pathogenic bacteria, but also bacteria belonging to the natural physiological flora, leading to their elimination and often to the complete sterilisation of areas where they should physiologically be present.
It should be added that antibiotics cause diarrhoea not only by unbalancing the intestinal microflora. They can directly interfere with the function of carbohydrate metabolism, leading to an accumulation of osmotically active compounds in the large intestine causing diarrhoea by an osmotic mechanism. Antibiotics may also interfere with the degradation of free bile acids, which act on colon epithelial cells to stimulate water secretion and cause secretory diarrhoea. Finally, it is important to remember that the pharmacological effects of antibiotics may be the cause of diarrhoea. The best documented is the adverse effect of erythromycin on the gastrointestinal tract, which stimulates gastrointestinal peristalsis through agonistic action on the motilin receptor. Some antibiotics can cause diarrhoea by several mechanisms.
In the context of safe and rational antibiotic therapy, the invaluable role of shielding drugs, i.e. probiotics, should therefore be emphasised. Restoring the balance of the bacterial flora and regenerating the saprophytic flora is just as important as eradicating the inflammation that caused the antibiotic. Probiotics, discovered in the early 20th century by Ilya Mechnikov, are defined as live, selected strains of micro-organisms that have a beneficial effect on the host organism by improving the balance of the intestinal microflora. They have found their use in the treatment of lactose intolerance and most types of diarrhoea, including post-antibiotic diarrhoea (also viral diarrhoea in children and infants, Clostridium difficile infection and traveller's diarrhoea).
Clinical studies suggest the use of probiotics for stimulation of the immune system, prevention of many allergic diseases, inflammatory diseases of the gastrointestinal tract and some cancers.
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The efficacy of probiotics in the prevention of post-antibiotic diarrhoea has been assessed in a number of systematic reviews with meta-analysis of randomised trials. These evaluated the efficacy of different probiotic strains(Saccharomyces boualrdii, L. acidophilus, L. bulgaricus, L. Rhamnosus GG, Bifidobacterium longum, Bifidobacterium bifidum and Str. thermophilus, Enterococcus faecium SF68).
In a meta-analysis involving 34 studies, Sazawal et al. showed that probiotics (including Saccharomyces boulardii, Lactobacillus rhamnosus GG, Lactobacillus acidophilus, Lactobacillus bulgaricus) significantly reduced the risk of post-antibiotic diarrhoea (by 52%). Kotowska et al. included 269 children (aged 6 months to 14 years) treated with antibiotics for otitis media and/or urinary tract infections in their study. The researchers evaluated the efficacy of Saccharomyces boulardii in preventing post-antibiotic diarrhoea. A reduced risk of diarrhoea was found in the group of patients receiving the probiotic, compared to the control group.
