Introduction: Probiotics are live microorganisms that, administered in adequate amounts, bring health benefits to the body. In practice, probiotics are indicated for various conditions, from mild diarrhea to conditions such as pseudomembranous colitis, irritable bowel syndrome, and an increase in the immune response. Their application becomes absolutely mandatory when it comes to antibiotic treatment, whose frequent adverse reaction is dysbiosis. As antibiotic use increases, so does the use of probiotics. The probiotics market was valued at USD 68.56 billion in 2022 and is expected to reach around USD 133.92 billion by 2030.
Aim: The aim of the current study is to summarize the current information available regarding the appropriate probiotic strains for each condition, to note some of the risks of probiotic treatment, and to make recommendations for the implementation of adequate pharmaceutical care.
Materials and Methods: A literature review was performed of available information in the World Gastroenterology Organization (WGO) guideline, Google Scholar, and PubMed, with statistics summarized by the World Health Organization, European Center for Disease Prevention and Control (ECDC).
Results and Discussion: According to WGO recommendations, suitable strains in antibiotic-associated diarrhea are Lactobacillus acidophilus, L. casei (≥ 10e10 cfu, once daily), Lactobacillus rhamnosus (10e10 cfu, twice daily), Saccharomyces boulardii (250 mg, twice daily), and in C. difficile infection – Lactobacillus acidophilus, L. casei (≥ 10e10 cfu, once daily), Saccharomyces boulardii (250 mg, twice daily). An important aspect is that the antibiotic and probiotic should be taken separately, in order to avoid antagonizing the two products and the deterioration of antibiotic resistance. They should be taken 2 hours apart. It is advisable to continue using probiotics for at least 2-3 weeks after stopping the antibiotic. The side effects of probiotics are known in 4 main directions: systemic infections, metabolically harmful processes, excessive immune stimulation in susceptible individuals, and gene transfer. However, probiotic microorganisms are believed to be non-pathogenic, and the theoretical risk of infections is very low (mainly in immunocompromised patients). Studies on strain-specific properties, the study of pharmacokinetics, and studies looking for interactions between the strain and the host would prove useful for their more rational application according to scientific sources.
Conclusion: Probiotics support the normal functioning of the gastrointestinal tract and prevent possible complications during antibiotic treatment. Each product contains one or more strains of bacteria, with different strains suitable for use in different conditions and antibiotic therapies. The regimen, dose, and duration of probiotic intake are determined by strain-specific properties. Pharmacists have a major role in the use of probiotics, based on patient opinion. Health professionals must obtain information about them from reliable sources and are required to warn patients about the peculiarities and risks of using probiotics.
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