Lactomin, Lactokids and Antibiotic Associated Diarrhea

Antibiotics are among the most widely prescribed medications. Along with their clearly established benefits in the treatment of infectious disease, antibiotics have many toxicities. These include disruption of the normal gastrointestinal microflora.

A common consequence of antibiotic therapy is antibiotic-associated diarrhea, which appears to be related to the suppression or elimination of healthy gut microorganisms. This is associated with a reduction in colonic short-chain fatty acid concentrations and an overgrowth of pathogenic organisms including Clostridium difficile.

Ingestion of healthful microorganisms known as probiotics is documented to reduce the risk of antibiotic-associated diarrhea and to be an effective treatment for recurrent Clostridium difficile-associated diarrhea. Clinical studies have shown that the most effective probiotics for antibiotic-associated diarrhea are Saccharomyces boulardii, Lactobacillus rhamnosus strains, and combinations of probiotics that usually contain Lactobacillus and Bifidobacterium species.

Research suggests that probiotics may be useful in combating antibiotic resistance among pathogens and may even be safe alternatives to antibiotics for select conditions. As newer and broader spectrum antibiotics are introduced, resistance rapidly and relentlessly follows. The specter of multi-drug resistant pathogens now haunts healthcare institutions.

The “anti-life” properties of antibiotics were quickly realized not to be restricted to bacteria. Many antibiotics were distinguished as so toxic that only topical use could be tolerated. Others were found to have significant adverse effects such as kidney or neurological toxicity. Doctors were slower to recognize that in addition to potential direct toxicity to patients, antibiotics indiscriminately kill normal, healthful bacteria along with pathogens.

Among the normal microflora reduced or eliminated by antibiotics are the essential Lactobacillus and Bifidobacterium species so crucial for gastrointestinal, genitourinary, and immune system health. The clinical consequences of disrupting the normal microflora include increased colonization and infection by pathogenic microbes, augmented risk of the emergence and spread of antibiotic resistant bacteria, and enhanced transmission of resistance factors among microorganisms.

Probiotics have been found to reduce the risk of AAD and CDAD. L. rhamnosus is a transient Lactobacillus that colonizes the small intestines when regularly consumed. Possibly the most extensively clinically studied of all probiotics, L. rhamnosus was once classified as L. casei and then as a subspecies of L. acidophilus; important information to consider when reviewing the medical literature. Lactobacillus species antagonize of an array of microbial pathogens, enhance innate and acquired immunity, and inhibit production of inflammatory mediators. Clinical studies have found that L. rhamnosus strains reduce the risk of AAD and improve outcomes in C. difficile diarrhea.

Probiotic microorganisms may interact synergistically with each other to provide benefits that a single strain or species alone may not. Animal studies consistently demonstrate that combinations of multispecies probiotics offer enhanced protection against such pathogens. Probiotic combinations that have been shown to reduce the incidence of AAD include Lactobacillus acidophilus and L. bulgaricus, L. acidophilus and Bifidobacterium lactis, L. acidophilus and B. infantis, L. acidophilus and B. longum, and B. lactis and Streptococcus thermophilus.

A meta-analysis of trials using probiotic combinations in children and adults found a significant reduction in the risk of AAD of 49%!