ARTHUR C. OUWEHAND*, JULIA TENNILÄ
*Corresponding author
DuPont Nutrition & Health, Active Nutrition, Sokeritehtaantie 20, 02460 Kantvik, Finland

Abstract

One of the oldest health benefits of probiotics is reduction of diarrhoea. Indeed, probiotics appear to be particularly effective in reducing the risk for side effects of antibiotic therapy. Here we summarise the effect a combination of four probiotic strains has on maintaining intestinal microbiota composition and reducing risk for antibiotic associated diarrhoea. Despite these successes, it is difficult to make reference to these benefits in many jurisdictions. It is therefore important that reference to alternative endpoints is made such as maintenance or restoration of microbiota composition or reduction of potential pathogens. This is important, not only for improving quality of life of patients on antibiotic use but also from a health economic perspective; the cost of probiotics is relatively small compared to the cost of antibiotic associated diarrhoea.

INTRODUCTION

Probiotics are defined as live microorganisms which when administered in adequate amounts confer a health benefit on the host (1). It may therefore not seem like a good idea to combine probiotics with antibiotics. However, one of the most convincing health benefits of probiotics has been the reduction of antibiotic associated diarrhoea (AAD) (2). Diarrhoea is one of the oldest health targets for probiotics. There may be various reasons why probiotics are effective in AAD despite the expected incompatibility of probiotics with antibiotics.

1. Probiotics may be resistant to the antibiotic in question. Bacteria commonly show resistance to some antibiotics. When most members of a particular species exhibit resistance to a certain antibiotic it may be due to intrinsic resistance; the target for the antibiotic maybe missing or maybe different and therefore the bacteria are not affected by the antibiotic (Figure 1). This type of resistance cannot be transferred and is therefore not a safety concern.
2. Alternatively, probiotics may have acquired antibiotic resistance. This will usually be found only among a limited number of st ...
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