Preliminary reportEffect of probiotics on preventing disruption of the intestinal microflora following antibiotic therapy: A double-blind, placebo-controlled pilot study
Introduction
It is known that antibiotics can detrimentally affect the ecological balance of the intestinal microflora [1], [2], [3] allowing the proliferation of naturally opportunistic organisms, such as yeasts, and potentially pathogenic bacteria. The effects of an antibiotic on the indigenous population depend on several factors including the antimicrobial spectrum, pharmokinetics, dose, route of administration and intestinal concentration [3]. Disruption of the normal flora by antibiotics is usually as a result of incomplete absorption of orally administered antibiotics as well as their secretion by the salivary glands. In the case of poorly absorbed antibiotic agents, they may disturb the balance in the large intestine which can lead to the development of conditions such as irritable bowel syndrome (IBS) [2].
Probiotics are live microbial food supplements that change either the composition or metabolic activities of the microflora, or modulate immune system reactivity in a way that benefits health [4], [5], [6], [7]. Probiotics have been given to healthy subjects receiving broad-spectrum antibiotics with only minor to moderate disturbances of the major bacterial groups [8], [9], [10]. In this study, the effects of probiotic supplementation both during and after broad-spectrum antibiotic therapy have been assessed in a clinical setting. Helicobacter pylori infected patients were selected for this study as a useful cohort of patients receiving a comparable antibiotic regime that could be timed to enable the collection of baseline specimens before the start of treatment. The use of eradication therapy for H. pylori has previously been shown to suppress the indigenous gastrointestinal anaerobic flora and increase numbers of aerobic organisms [11], [12] and the aim of this study was to observe the effects of two programmes of probiotic supplementation on the response of the microflora to eradication therapy.
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Patients
Thirty patients were recruited into the study at Addenbrooke's Hospital, Cambridge, UK. Patients recruited to the study had been found at endoscopy to be infected with H. pylori that was verified by positive serology and histology by the Public Health Laboratory Service at Addenbrooke's Hospital. The patients were otherwise healthy with no other gastrointestinal disorders apart from peptic ulcers, thought to be related to their H. pylori infection. They had not received any antibiotics or been
Results
The results of microbial populations in different groups at key sampling days are shown in Table 1. In the placebo group (Group I), numbers of total facultative anaerobes increased significantly during triple-therapy from day 1 to day 7 (P < 0.05). The numbers of facultatives were significantly lower at days 12 and 17 than at day 7 (P < 0.05), but the population at day 12 was still significantly higher than at day 1 (P < 0.05). The re-growth populations at day 27 remained significantly elevated
Discussion
The role of triple-therapy in the eradication of H. pylori is well established with the most common eradication currently consisting of two antibiotics chosen from amoxycillin, tetracycline, metronidazole or clarithromycin and a proton pump inhibitor [12], [13]. Increases in the numbers of the facultative anaerobic component of the microflora during triple-therapy are probably due to the activity of amoxycillin, which has previously been shown to cause proliferation of enterobacteria both in
Acknowledgements
This work was supported by a grant from the Teaching Company Scheme, UK. We would like to thank Vanessa Davies and Tinnu Sarvotham for technical assistance and Dr Sarah Shore for statistical advice.
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