Do Probiotics Help Restore the Microbiome After a Course of Antibiotics?
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Probiotics can offer benefits in restoring the gut microbiome after antibiotic treatment, particularly in preventing antibiotic-associated diarrhea and promoting the growth of beneficial bacteria. However, their effectiveness can vary, and in some cases, they may not fully restore the microbiome as effectively as other methods like aFMT. The choice of probiotic strains and the individual’s baseline microbiota condition are critical factors influencing the outcome.
The use of probiotics to restore the gut microbiome after antibiotic treatment has been a topic of significant research interest. Antibiotics can disrupt the gut microbiota, leading to various health issues, and probiotics are often considered a potential solution to mitigate these effects.
Key Insights
- Probiotics and Microbiota Composition:
- Probiotics can help restore the microbiota composition disrupted by antibiotics, particularly in infants when combined with breastfeeding1.
- Probiotic supplementation can lead to a modest improvement in microbiota recovery after antibiotic treatment, linked to the detection and replication of specific probiotic strains3.
- Probiotics can suppress the outgrowth of harmful bacteria like Enterobacteriaceae and promote beneficial bacteria such as Firmicutes during the recovery phase5.
- Probiotics and Gut Health:
- Probiotics are effective in preventing antibiotic-associated diarrhea (AAD) and Clostridium difficile-associated diarrhea (CDAD), reducing the risk of these conditions significantly6 7.
- Probiotics can enhance the recovery of gut microbiota disrupted by antibiotics, which is crucial for the efficacy of treatments like immune checkpoint blockade (ICB) therapy in cancer4.
- Limitations and Challenges:
- Probiotics may delay and incompletely restore the indigenous microbiome compared to spontaneous recovery or autologous fecal microbiome transplantation (aFMT)2.
- The effectiveness of probiotics in restoring microbiota varies depending on the specific strains used and the individual’s existing microbiota condition9 10.
Do probiotics help restore the microbiome after a course of antibiotics?
Kate Secombe has answered Unlikely
An expert from University of Adelaide in Microbiome, Cancer
This situation was often thought to be where probiotics would be most useful. There has been some evidence to show that probiotics can reduce antibiotic-induced diarrhoea (https://jamanetwork.com/journals/jama/fullarticle/1151505), and anecdotally, many people report using probiotics to restore the microbiome after antibiotics.
However, a recent study (https://www.ncbi.nlm.nih.gov/pubmed/30193113) has shown that after a course of antibiotics, people who took probiotics took longer to restore a normal microbiome compared to people who did nothing, or people who had an autologous faecal microbiota transplant (a sample of your own stool readministered to you after antibiotics). In addition, those who took probiotics had less of the normal gene expression you would expect from your microbiome compared to other groups. This is only one study though, and more research may be needed to see if these results are reproducible in other cohorts of participants.
So overall, the jury is still out on this, but if you are otherwise healthy, you may be best off letting your microbiome restore itself, helped along with a varied diet including lots of fibre (https://www.ncbi.nlm.nih.gov/pubmed/28165863).
Do probiotics help restore the microbiome after a course of antibiotics?
Arthur C Ouwehand has answered Likely
An expert from DuPont Nutrition and Health in Microbiology
There is quite good evidence that consuming probiotics along with antibiotics speeds up the recovery of the intestinal microbiota.
https://www.ncbi.nlm.nih.gov/pubmed/26395781
Do probiotics help restore the microbiome after a course of antibiotics?
Hannah Wardill has answered Uncertain
An expert from University of Adelaide in Gastroenterology, Microbiome
This remains a challenging concept. There is certainly some evidence to show that probiotics help restore the microbiome after an insult like antibiotics. In fact, probiotics are widely prescribed after a course of antibiotics which is based on strong preclinical work (Ekmekciu et al., 2017) and variable clinical research (Olek et al. 2017, Allen et al., 2017). These studies have been largely supportive of probiotic use after antibiotics, however they primarily assess the faecal microbiome using 16S sequencing. This approach does not differentiate between dead and alive bacteria, nor does it assess the functional aspects of the microbiome. As such, the results simply show that there is a greater presence of microbes in the stool. The benefits to the host are unclear (i.e. no long term follow up to evaluate post antibiotic complications/disease and no functional evaluations of the participants). The largescale recommendations to take probiotics after antibiotics likely reflects the “they are harmless” attitude towards probiotics.
There is also evidence to suggest that probiotics are not the most efficient way to promote intestinal recovery. Authors emphasise that probiotics are usually a simple formulation of one or only a few microbes, which may or may not have been affected by the antibiotics. Most recently, a study by Eran Elinav’s group in Isreal demonstrated that probiotics can in fact hinder the recovery of the microbiome after antibiotics. In fact, probiotic supplementation was shown to delay microbial recovery. Critically, this study compared recovery of the microbiome with probiotics in comparison to autologous FMT (aFMT). This is where stool is collected from people prior to a planned insult (e.g. antibiotics). It is then processed and re-administered to the participant at a later date. A single aFMT in this study was able to induce a rapid and near complete recovery of the microbiome suggesting that a personalised approach using a large microbial load of high diversity (like that of an FMT) is a more effective approach to restoring the microbiome after insult.
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