93
the antibiotics disrupting the normal flora in the gut of a healthy person. Such disrup-
tions cause dysfunction of the gut’s ecosystem and allow pathogens to colonize the gut
and gain access to the mucosa. A number of organisms have been studied as probiotics to
prevent antibiotic-associated and C difficile-associated diarrhea (see Table 1).39 Whether
probiotic supplements stop this process by reducing the disruption or by acting as substi-
tutes for healthy flora is unclear.
Table 1. Strain-Specific Organisms Researched in the Prevention and Treatment of
Antibiotic-Associated Diarrhea •
•• Bifidobacterium
•• Lactobacillus GG (LGG)a
•• Lactobacillus casei
•• Lactobacillus plantarum 299v
•• Enterococcus faecium (SF68)
•• Saccharomyces boulardiia
•• Saccharomyces cerevisiae
•• Bacillus clausii
•• Clostridium butyricum
•• Lactobacillus acidophilus
• a S boulardii and LGG are the most promising.
Source: Reference 39.
Final Thoughts
Recent evidence has shown that microbes and their genes play important roles in the
development of our immune systems, in the production of fatty acids that enhance
healthy intestinal cell growth, in elaborating molecules that inhibit the growth and viru-
lence of enteric bacterial pathogens, and in the detoxification of ingested substances that
could otherwise lead to cancerous cell growth or alter our ability to metabolize medi-
cines.40,41 Pharmacists will thus become more involved in counseling patients interested in
taking probiotics. In Europe, probiotics are regarded as medicines and prescribed along
with antibiotics.42 In the US, pharmacists can advise patients to take such products as
Culturelle, Florajen or Flora-Q while on antibiotics and for three to seven days thereafter.43
The same products can be taken to help prevent traveler’s diarrhea. They should be taken
a few days before the trip and continued through its duration. Instruct patients to separate
any probiotic and antibiotic doses by two hours to prevent the antibiotic from destroying
the probiotic organisms.44 Immunocompromised patients should be advised not to use
probiotics because of the potential for systemic infections. Other side effects can include
GI upset (e.g., flatulence, discomfort).
References
1. Martin A. In live bacteria, food makers see a bonanza. NY Times. January 22, 2007.
2. Ibid.www.nytimes.com/2007/01/22/business/22yogurt.html. Accessed September 2, 2009.
3. DanActive. Dannon. www.danactive.com. Accessed September 10, 2009
4. Probiotics for digestive health. Pharmacist’s Letter. 2006 7(22):220704.
5. Friedrich MJ. Benefits of gut microflora under study. JAMA. 2008 299:162.
6. Zuger A. Separating friend from foe among the body’s invaders. NY Times. November 27, 2007. www.nytimes.
com/2007/11/27/health/27book.html. Accessed September 2, 2009.
7. Ibid.
8. Sacks JS. Good Germs, Bad Germs. New York, NY: Hill &Wang 2007.
9. Ibid.
10. Macfarlane GT, Cummings JH. Probiotics and prebiotics: can regulating the activities of intestinal bacteria ben-
efit health? BMJ. 1999 318:999-1003.
11. Intestinal flora. http://tuberose.com/Intestinal_Flora.html. Accessed September 2, 2009.
Probiotics and Microflora
the antibiotics disrupting the normal flora in the gut of a healthy person. Such disrup-
tions cause dysfunction of the gut’s ecosystem and allow pathogens to colonize the gut
and gain access to the mucosa. A number of organisms have been studied as probiotics to
prevent antibiotic-associated and C difficile-associated diarrhea (see Table 1).39 Whether
probiotic supplements stop this process by reducing the disruption or by acting as substi-
tutes for healthy flora is unclear.
Table 1. Strain-Specific Organisms Researched in the Prevention and Treatment of
Antibiotic-Associated Diarrhea •
•• Bifidobacterium
•• Lactobacillus GG (LGG)a
•• Lactobacillus casei
•• Lactobacillus plantarum 299v
•• Enterococcus faecium (SF68)
•• Saccharomyces boulardiia
•• Saccharomyces cerevisiae
•• Bacillus clausii
•• Clostridium butyricum
•• Lactobacillus acidophilus
• a S boulardii and LGG are the most promising.
Source: Reference 39.
Final Thoughts
Recent evidence has shown that microbes and their genes play important roles in the
development of our immune systems, in the production of fatty acids that enhance
healthy intestinal cell growth, in elaborating molecules that inhibit the growth and viru-
lence of enteric bacterial pathogens, and in the detoxification of ingested substances that
could otherwise lead to cancerous cell growth or alter our ability to metabolize medi-
cines.40,41 Pharmacists will thus become more involved in counseling patients interested in
taking probiotics. In Europe, probiotics are regarded as medicines and prescribed along
with antibiotics.42 In the US, pharmacists can advise patients to take such products as
Culturelle, Florajen or Flora-Q while on antibiotics and for three to seven days thereafter.43
The same products can be taken to help prevent traveler’s diarrhea. They should be taken
a few days before the trip and continued through its duration. Instruct patients to separate
any probiotic and antibiotic doses by two hours to prevent the antibiotic from destroying
the probiotic organisms.44 Immunocompromised patients should be advised not to use
probiotics because of the potential for systemic infections. Other side effects can include
GI upset (e.g., flatulence, discomfort).
References
1. Martin A. In live bacteria, food makers see a bonanza. NY Times. January 22, 2007.
2. Ibid.www.nytimes.com/2007/01/22/business/22yogurt.html. Accessed September 2, 2009.
3. DanActive. Dannon. www.danactive.com. Accessed September 10, 2009
4. Probiotics for digestive health. Pharmacist’s Letter. 2006 7(22):220704.
5. Friedrich MJ. Benefits of gut microflora under study. JAMA. 2008 299:162.
6. Zuger A. Separating friend from foe among the body’s invaders. NY Times. November 27, 2007. www.nytimes.
com/2007/11/27/health/27book.html. Accessed September 2, 2009.
7. Ibid.
8. Sacks JS. Good Germs, Bad Germs. New York, NY: Hill &Wang 2007.
9. Ibid.
10. Macfarlane GT, Cummings JH. Probiotics and prebiotics: can regulating the activities of intestinal bacteria ben-
efit health? BMJ. 1999 318:999-1003.
11. Intestinal flora. http://tuberose.com/Intestinal_Flora.html. Accessed September 2, 2009.
Probiotics and Microflora