Up to one in five people on antibiotics stop taking their full course of antibiotic therapy due to diarrhea. Physicians could help patients avoid this problem by prescribing probiotics, according to a study by researchers at Albert Einstein College of Medicine of Yeshiva University published in American Family Physician.
Antibiotics target “bad” bacteria but may also kill the “good” bacteria in the large intestine, leading to diarrhea. Diarrhea can also result from bacterial and viral infections.
Probiotics -- cultures of “good” microorganisms similar to those normally found in the gut - have been promoted as restoring the microbial balance disrupted by antibiotics and infections. Probiotic bacterial strains are available as powders and pills and are added to select yogurts and brands of miso, which are otherwise low in concentration.
The Einstein scientists reviewed the medical literature and found seven, high-quality studies in which probiotics were administered to people. The researchers concluded that the studies support the use of probiotics for avoiding diarrhea resulting from antibiotic use or from gastrointestinal viral or bacterial infections. In addition, the probiotics used in these studies were found to rarely cause adverse effects, even in children.
“With the level of evidence that probiotics work and the large safety margins for them, we see no good reason not to prescribe probiotics when prescribing antibiotics,” says Dr. Benjamin Kligler, a co-author of the study and associate professor of clinical family and social medicine at Einstein. “The only drawback is that probiotics are not covered by health insurance.” On average, a one-month supply of probiotics costs between $18 and $32.
Dr. Kligler notes that the effects of probiotic doses are short-lived, so they should be taken throughout a course of antibiotic therapy. Probiotics will not diminish the effectiveness of antibiotics, he adds.
Products vary widely in bacterial dose and in quality. The Einstein paper specifies several commercial probiotic preparations of sufficient strength to offer health benefits. In general, probiotic doses of more than 5 billion colony-forming units per day for children and more than 10 billion colony-forming units per day for adults were associated with the best outcomes.
Dr. Kligler believes that physicians should be aware of specific brands so they can recommend only those known to be of quality.
“In our residency program, we’ve worked hard to train our physicians to consider probiotics as an option,” says Dr. Kligler. “Now they are pretty good at regularly prescribing probiotics when they put a patient on antibiotics. But the average doctor is not doing this, and patients often know more about probiotics than their physicians do.”
Dr. Kligler’s co-author was Dr. Andreas Cohrssen, director of the Beth Israel Medical Center Residency Program in Urban Family Practice.
Disclosure: Neither Benjamin Kligler nor Andreas Cohrssen has any financial ties to usprobiotics.org or the manufacturers of probiotics.
About Albert Einstein College of Medicine of Yeshiva University
Albert Einstein College of Medicine of Yeshiva University is one of the nation’s premier centers for research, medical education and clinical investigation. It is the home to some 2,000 faculty members, 750 M.D. students, 350 Ph.D. students (including 125 in combined M.D./Ph.D. programs) and 380 postdoctoral investigators. Last year, Einstein received more than $130 million in support from the NIH. This includes the funding of major research centers at Einstein in diabetes, cancer, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Through its extensive affiliation network involving five hospital centers in the Bronx, Manhattan and Long Island – which includes Montefiore Medical Center, Einstein’s officially designated University Hospital – the College runs one of the largest post-graduate medical training program in the United States, offering approximately 150 residency programs to more than 2,500 physicians in training. For more information, please visit www.aecom.yu.edu.
Albert Einstein College of Medicine of Yeshiva University Released: Wed 17-Dec-2008
The paper, “Probiotics,” was published in the November 1st issue of American Family Physician http://www.aafp.org/afp/20081101/1073.html.