Nonadherence to antibiotic treatment due to diarrhea is a common concern among healthcare professionals when treating infection. Probiotics, more researchers are finding, can greatly reduce antibiotic-associated diarrhea (AAD) when taken two hours after the first antibiotic dose.

Several studies support the nutraceutical use of probiotics including two analyses steered by behavioral scientist Susanne Hempel, co-director of Southern California Evidence-Based Practice Center.

In her 2006 meta-analysis, 11,811 participants in 82 randomized, controlled trials who reported experiencing diarrhea while taking antibiotics showed a 42-percent reduced risk with probiotic supplementation. A 2012 clinical review by the same authors noted an increased interest in probiotic intervention as well as evidence of its effectiveness in preventing AAD.

The Journal of the American Medical Association article “Probiotics Revisited,” from a 2014 Medical Letter on Drugs and Therapeutics, further concludes that probiotics such as lactobacillus spp and saccharomyces can help abate AAD with few, if any, adverse effects.

Preventing AAD in Children

Incorporating probiotics is especially beneficial in treating young children who are frequently exposed to respiratory ailments that often lead to bacterial infections. Studies have found that up to 50 percent of children who receive antibiotics for ear infections will develop AAD.

Consider the case of Peter, a 4-year-old preschooler who developed a sore throat and fever that advanced into bronchitis. His pediatrician prescribed an antibiotic, which remedied the cough, but also caused severe diarrhea that resulted in a trip to the emergency room and the diagnosis of AAD.

Brian, an 8-month-old diagnosed with an ear infection, had a different experience. The doctor prescribed an antibiotic, but also recommended adding a probiotic. The infection healed without the occurrence of diarrhea and potentially fatal dehydration.

In fact, a study published by the Cochrane Library in 2015 revealed new evidence supporting the use of probiotics to prevent pediatric AAD. Twenty-three clinical trials in 3,938 newborns to children age 17 compared probiotics, placebo and non-treatment to measure the occurrence of diarrhea resulting from antibiotic use. The study also looked for any harmful side effects attributed to using probiotics for this purpose.

While most controlled studies to date have analyzed lactobacillus, the Cochrane trial also included bacillus spp., bifidobacterium spp., clostridium butyricum, lactobacilli spp., lactococcus spp., leuconostoc cremoris, saccharomyces spp. and streptococcus spp, either alone or combined. The results revealed a much lower incidence of AAD – just eight percent – in the probiotic group compared to 19 percent among control group participants. Adverse side effects attributable to the probiotics were hardly palpable among otherwise healthy children, compared to a host of undesirable events with the placebo, standard care and non-treatment groups that included nausea, gas, bloating and constipation. The authors of the study therefore concluded measurable, moderate-quality benefit to using probiotics in healthy individuals as compared to not.

Choosing a probiotic

Because different bacterial strains provide different benefits, choosing a probiotic containing several cultures that can work symbiotically is best when aiming to prevent AAD.

EndoMune Advanced Probiotic for adults provides 20 billion probiotic bacteria CFU consisting of ten naturally occurring bacterial strains, plus the boosting prebiotic fructooligosaccharide (FOS). EndoMune Jr. consists of four bacterial strains and provides10 billion CFU.