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.
The McFarland meta-analysis included 31 randomised trials (more than 3,000 patients). Probiotics (mainly strains of Saccharomyces boulardii, Lactobacillus rhamnosus GG and a mixture of probiotics) were found to significantly reduce the risk of diarrhoea following antibiotic use (25 studies)and to prevent diarrhoea of Clostridium difficile aetiology (6 studies). Clinical studies analysing the efficacy of Lactobacillus rhamnosus GG confirmed that in patients who took a probiotic during antibiotic treatment, nausea and vomiting occurred in 10 per cent and diarrhoea in 3.3 per cent of patients, while in the remaining patients (not taking a probiotic during antibiotic treatment), nausea and vomiting affected 37 per cent and diarrhoea as much as 27 per cent.
The results of the meta-analyses therefore clearly demonstrate that the use of probiotics with proven effects reduces the risk of post-antibiotic diarrhoea by an average of 60%. This is particularly important in the group of minor patients, in whom dehydration and electrolyte-ion disorders in the course of diarrhoea can be particularly dangerous and necessitate hospitalisation. Probiotic strains with documented efficacy are: Lactobacillus rhamnosus GG, Saccharomyces boulardii, Bifidobacterium lactis Bb12, Streptococcus thermophilus and Lactobacillus rhamnosus.
One might ask, instead of probiotic preparations in capsules, drops or sachets, is it not better to give yoghurt prophylactically during antibiotic therapy? Yoghurt is produced by the fermentation of milk by L.bulgaricus and Streptococcus thermophilus. Other lactic acid bacteria are currently being added. At present, there is a lack of results from reliable randomised trials evaluating the effectiveness of yoghurt in the prevention of post-antibiotic diarrhoea. In studies conducted on children >1 year of age as well as adults, the group receiving bio-yoghurt compared to the group receiving plain yoghurt or no prophylactic treatment at all, did find a lower incidence of diarrhoea (6%, 11% 14% respectively), but these differences were not statistically significant.
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The results of this systematic review and meta-analysis demonstrate the efficacy of certain probiotic bacteria in preventing antibiotic-associated diarrhoea and provide a rational rationale for their use. Probiotics are safe, even recommended for pregnant women and newborns. To date, no adverse effects have been reported during their use.
In Poland, preparations are available with the following probiotic bacteria with documented activity in preventing diarrhoea associated with antibiotic use:
1. lactobacillus rhamonosus GG
2. saccharomyces boulardii
3. bifidobacterium lactis Bb12 and Streptococcus thermophilus.
It should also be remembered that diarrhoea associated with antibiotic therapy is usually self-limiting. The decision to use probiotics during antibiotic therapy should therefore be made individually for each patient.
