The role of probiotics in antibiotic therapy

In recent years, the growing interest in gut microbiota and its importance for overall health has changed the approach to pharmacological therapies, including antibiotics. While antibiotics are fundamental in combating bacterial infections, their overuse can lead to intestinal dysbiosis and, consequently, numerous health problems. Therefore, the inclusion of probiotics is essential as a preventative measure and to support microbiota homeostasis.

Antibiotic therapy and its impact on the intestinal microbiota

Antibiotics work by destroying pathogenic bacteria, but their broad spectrum can also damage beneficial intestinal bacteria, primarily Bifidobacterium and Lactobacillus. Various sources indicate that, depending on the state of the intestinal microbiota and the duration of antibiotic therapy, the restoration of bacterial flora can take from several weeks to several months. In some cases, without the support of appropriate probiotic supplementation, it can take over two years to return to homeostasis.

The most common consequences of antibiotic use include intestinal dysbiosis, which can lead to diarrhea, the development of infections with opportunistic bacteria such as Clostridium difficile , and increased permeability of the intestinal barrier, which causes inflammatory reactions and the associated risk of autoimmune and metabolic diseases.

Probiotics – definition and mechanisms of action

Probiotics are live microorganisms that, when administered in appropriate doses, have a beneficial effect on the host's health. Among the most commonly used probiotic strains are lactic acid bacteria, such as Lactobacillus acidophilus, Lactobacillus rhamnosus GG, Lactobacillus reuteri , and Bifidobacterium lactis . Their action is based on several basic mechanisms:

• colonization of the intestinal mucosa – probiotics compete with pathogens for adhesion sites and nutrients;
• production of metabolites with antibacterial activity – such as organic acids – which inhibit the growth of pathogenic bacteria;
• modulation of the immune response – probiotics can support the development of immune tolerance mechanisms and reduce reactivity to pathogens.

The role of probiotics in antibiotic therapy

The use of probiotics during antibiotic therapy has numerous potential benefits, but their effectiveness depends on the proper selection of strains, dosage, and duration of use. Research indicates that appropriately selected probiotic strains can reduce the risk of antibiotic-associated diarrhea and support faster recovery. intestinal microbiota by accelerating the colonization of the intestines with beneficial microorganisms, reducing the risk of colonization by pathogenic bacteria and increasing resistance to opportunistic infections caused by, for example, Clostridium difficile overgrowth, which is resistant to antibiotics.

Which probiotic should you choose?

When choosing a probiotic, it's worth choosing the proven, best one. Information such as:

• the name of the bacteria must consist of three parts – genus (e.g. Lactobacillus ), species (e.g. acidophilus ), strain (e.g. Er-2 317/402 Narine),
• the bacterium is clinically tested,
• the number of bacteria in the preparation – the CFU value, i.e. colony forming units; in available preparations it is ¹⁰⁶ - ¹⁰¹⁰ , which means that the higher the power, the more bacteria in the capsule to colonize in the intestines;
• composition – are there any fillers or anti-caking agents, the presence of which is at the expense of the number of bacteria?

Additionally, the introduction of probiotics as a supplement to antibiotic therapy requires consideration of several key factors:

• strain selection – the effectiveness of probiotics depends on the strain, which must be matched to the therapeutic purpose,
• time and method of administration – it is recommended to administer the probiotic at least 2 hours before or after the antibiotic to reduce the risk of its destruction by the antibiotic,
• Length of supplementation – for optimal results, probiotics should be used throughout the duration of antibiotic therapy and continued for at least 6 weeks after its completion to support the body in rebuilding the intestinal microflora; the duration of supplementation is an individual matter, depending on the condition of the intestinal microflora, diet, and lifestyle.

Lactobacillus acidophilus strain Er-2 317/402 Narine is exceptionally effective because it exhibits high adaptability, surviving in the acidic environment of the stomach and remaining in the intestines for a long time. It has pronounced adhesive properties, sealing the intestinal mucosa and preventing pathogens and toxins from entering the body. Furthermore, it exhibits high antibacterial activity, producing bacteriocins (natural antibiotics), and supports and promotes the production of interferon – a natural substance produced by the body's cells responsible for the immune system. Furthermore, Narine helps in the absorption of vitamins and minerals such as calcium and phosphorus.

Guidelines for the use of probiotics in antibiotic therapy

Currently, the use of probiotics is not standard in all antibiotic therapy, but their benefits have been recognized in the prevention of selected complications, especially in high-risk groups. According to international guidelines (including those of the European Society of Gastroenterology), probiotics are primarily recommended for the prevention of antibiotic-associated diarrhea, particularly in children and the elderly. However, there is a growing body of research on the contribution of the gut microbiome to the incidence of gastrointestinal and even neurological diseases through the action of the gut-brain axis. The microbiome is becoming increasingly appreciated in the context of maintaining overall health, and the number of destructive factors affecting humans today requires supplementation to maintain homeostasis.

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