Can Probiotics Help When Antibiotics Are Needed?
A patient came to me with a confusing situation this week. He was in after extensive antibiotic therapy for an infection deep in his prostate. While he had felt better in regards to his urination, he now has some new problems. Over the last couple weeks, he developed fever, chills, and diarrhea. This had already been a long, drawn-out process, and he was obviously frustrated. Was the infection still there, or had it spread? Could this be a side effect of the antibiotic?
At the culmination of our visit, I concluded that he was suffering from an all-to-common problem: Antibiotic-Associated Diarrhea (AAD). I recently reviewed the notion of using probiotics to prevent AAD, and I've provided some guidelines, should you require antibiotic therapy.
The Problem of AAD
Antibiotics are designed to kill bacteria. As killers, they are more "Rambo" than "Sniper." In other words, they kill indiscriminately. The problem with this is that our bodies harbor "normal" bacteria in places such as the mouth, bowels, and vagina that help with body processes like digestion and metabolism. When these bacteria are eradicated with antibiotics, they usually replenish naturally. However, bad, infectious bacteria or fungi can populate the body where the healthy bacteria once thrived. Besides vaginal yeast infections, the most common consequence of this phenomenon is antibiotic associated diarrhea.
Among AAD infections, the most common is a bacteria called clotridium difficile (c. dif). These infections are a serious problem, and they're on the rise. Between 2002 and 2009, AAD infections have doubled, and health expenses related to AAD are increasing. Recent estimates place the cost of c. dif infections to the U.S. health system at approximately $1.3 billion annually. Furthermore, resistance to the typical antibiotics used to treat these infections is growing, making things more challenging. As such, any potential to cut down on the risk of AAD is welcome. Enter probiotics.
Probiotics are the body's "good" bacteria in a form that can be taken orally. This typically comes as a capsule or in yogurt. In general, probiotic therapy is considered safe for all ages and can be purchased without a prescription at any pharmacy or health food store. Cost may be variable but is somewhere in the range of $20 for a one-month supply. Most insurance plans won't cover probiotics.
Probiotics and Reduction in AAD Risk
Recent studies involving groups of all ages who were using various antibiotics and being treated for a number of different conditions revealed, through statistical analysis, that taking a probiotic at the end of antibiotic therapy reduced the risk of AAD by about 50%. The data also determined that it would take the use of a probiotic in 13 cases to prevent just one case of AAD.
Administration with Antibiotic Therapy
Probiotics should be used toward the tail end of antibiotic therapy. Remember, the antibiotic kills all different forms of bacteria. It's important, however, that the probiotic be first on the scene when the last dose of the antibiotic leaves the body. For this reason, start the probiotic on the last day of antibiotic therapy or immediately after the last dose. I generally recommend 1-2 weeks of therapy, though there is no uniform standard for this.
Why not take a probiotic with antibiotic therapy? In this situation, there is really nothing to lose and everything to gain. AAD is a large problem, and the risk is sufficient to warrant preventative probiotic therapy. While prevention of AAD is not assured, it will cut down the risk by about 50%, and that's better than nothing.
Hampel et al. Probiotics for the Prevention and Treatment of Antibiotic Associated Diarrhea. JAMA. 2012; 307:159-69.