Data Collection And Analysis
The appropriate unit of analysis was the individual patient. For all outcomes, where possible, an intention-to-treat analysis was performed, otherwise the available case analysis was used. The statistical heterogeneity was assessed using the I2 statistic, interpreted according to the Cochrane Handbook , and considered substantial if I2 was greater than 50%. If there were ten or more studies in the meta-analysis , reporting biases were investigated using funnel plots and reasons for asymmetry were considered if they were noted.
The Review Manager software was used to calculate summary statistics using a random-effects model. For continuous data, the mean difference was provided if outcomes were measured in the same way among trials and standardised mean difference if not. For dichotomous data, the results were presented as a summary risk ratio with 95% confidence intervals . Where substantial heterogeneity was present, potential explanations were considered including subgroup analysis, and sensitivity analyses were conducted based on the risk of bias in which studies with the highest level of bias or unclear bias for allocation concealment and completeness of outcome data were excluded.
Subgroup analyses for the following were considered where possible:
Type of probiotics
Type of infection.
Studies Of Commercial Products Limited
Newberry says none of the studies included in the analysis examined commercially available probiotic yogurts, and very few examined commercially marketed probiotic supplements.
In most cases these were mixtures created in the lab for the individual study, she tells WebMD.
Many types of bacteria or yeasts are considered to be probiotics, and commercially available supplements contain different combinations of these microorganisms.
At this point the research doesnt say much about which microorganisms work best, she says.
And because dietary supplements are not regulated in the United States, buyers are on their own trying to figure out which ones to take.
Im afraid nothing in this review will help consumers choose which probiotic supplement to choose or which foods to eat, says David Bernstein, MD, who is chief of the division of hepatology at North Shore University Hospital in Manhasset, N.Y.
All agree that more study is needed to identify which microorganisms best benefit the gut.
In high-risk patients which would include elderly people in nursing homes taking antibiotics it is probably not a bad idea to give a probiotic, Quigley says. But if you ask me which one, I really couldnt tell you.
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Other Possible Uses Of Probiotics In The Elderly
Probiotics have been shown in clinical trials to be effective in a wide variety of conditions other than those discussed above. Although these studies have not specifically involved elderly subjects, it is not unreasonable to suppose that the results could also apply to this group.
An intriguing possibility is that LAB may have a role in prevention of malignancy. In vitro and animal studies suggest various possible anticarcinogenic effects, possibly by altering faecal enzymes so that production of potential carcinogens, such as nitrite and azo compounds, is minimised. The action of probiotics, described in the previous section, in increasing the activity of NK cells, whose targets include tumour cells, may also have a part to play in the prevention of development of cancers. There are grounds for optimism from epidemiological studies, some of which show lower incidences of some types of cancer associated with regular consumption of fermented milk products.
Two randomised clinical trials from Japan indicated that L casei Shirota significantly decreased the chance of recurrence of bladder tumours in man.
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What Types Of Bacteria Are In Probiotics
Probiotics may contain a variety of microorganisms. The most common are bacteria that belong to groups called Lactobacillus and Bifidobacterium. Other bacteria may also be used as probiotics, and so may yeasts such as Saccharomyces boulardii.
Different types of probiotics may have different effects. For example, if a specific kind of Lactobacillus helps prevent an illness, that doesnât necessarily mean that another kind of Lactobacillus or any of the Bifidobacterium probiotics would do the same thing.
Probiotics Prebiotics And The Immune System
The ability of the body to mount an effective defensive response to disease declines with age, a phenomenon known as immunosenescence. Elderly people may indeed be regarded as immunocompromised. Cellular immunity seems to be the most seriously affected, with decreased numbers of circulating CD3+ lymphocytes and diminished activity of natural killer cells. Clearly, any strategy that can boost immunity in the elderly is to be welcomed.
Various probiotic bacteria, including yoghurt organisms, L johnsonii La1, L acidophilus, L casei and B lactis Bb12, have been shown on the basis of in vitro and ex vivo models to have immunostimulatory properties, including modulation of cytokine production, increased phagocytic activity of polymorphs, adjuvant effects on specific humoral responses, T lymphocytic function, and NK activity.
It remains to be demonstrated whether the apparently beneficial effects of probiotics and prebiotics on various immune parameters, as outlined above, is of practical significance. An interesting finding in this respect was made by Turchet et al who supplemented the diet of a group of healthy elderly subjects with L casei for three weeks, and reported that the duration of winter infections was decreased by 20% compared with a control group.
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Which Probiotics Should You Add To Your Diet
Probiotics are commonly found in food. They are also available in dietary supplements.
Food. Many foods have good bacteria. However, these bacteria donât always survive strong stomach acids and may not be able to add to gut health. Other foods have probiotic strains that can survive the digestion process and successfully reach the gut.
âWhether a food truly has beneficial probiotics depends on three things: the levels of good bacteria contained when eaten, whether the good bacteria can survive passage through the stomach, and whether those strains of bacteria are able to support your health.â
These are a few foods that provide a good source of probiotics:
- dried beans and other legumes
Dietary supplements. Probiotics are also available as capsules, powders, liquids, and more. The wide variety of available products can make it difficult to determine which ones offer health benefits based on science.
Some of the best probiotic strains for health include:
Lactobacillus acidophilus. Lactobacillus acidophilus balances potentially harmful bacteria that can otherwise grow in your gut due to illness or antibiotics.
Lactobacillus fermentum. Lactobacillus fermentum strengthens your immune system and prevents gastrointestinal and upper respiratory infections.
Lactobacillus casei/paracasei. Lactobacillus casei/paracasei can ease inflammatory bowel disease â a common disorder that causes cramping, abdominal pain, bloating, gas, and diarrhea or constipation).
What Is The Rationale Behind Taking Probiotics With Antibiotics
Taking an antibiotic for an infection can kill beneficial bacteria that live in your gut.
Probiotics may be taken orally to restore any imbalance in the normal intestinal or urogenital flora. This is the rationale behind taking probiotics with antibiotics. Severe antibiotic-induced diarrhea can also lead to an infection with Clostridium difficile, also known as C. difficile, a bacteria which can cause dangerous inflammation in your colon .
Experts have hypothesized that If you suffer from stomach cramping, gas or diarrhea when you take antibiotics, adding a probiotic may help to lessen, or even prevent, these symptoms. The addition of a probiotic will also reintroduce helpful bacteria into your digestive tract that have been killed or had their numbers reduced by the antibiotic.
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Are There Any Risks Associated With Taking Probiotic Supplements As An Older Adult
Older adults are increasingly turning to probiotic supplements to improve their health. But while probiotics offer many potential benefits, there is also the potential for risk. Its important for older adults to be aware of these risks before starting a probiotic supplement regimen.
One potential risk associated with taking probiotic supplements is that they may interact with other medications an individual is taking. For example, if an older adult is taking antibiotics, the probiotics may reduce the effectiveness of the antibiotics. This could lead to serious health problems for the individual.
Another risk associated with probiotic supplements is that they may not be effective in all people. In some cases, individuals have reported no change in their health after taking probiotic supplements for an extended period of time.
Research has shown that older adults can benefit from probiotic supplements, as they help to improve gut health and overall general health. However, there are a few risks associated with taking these supplements as an older adult.
For instance, if you are on antibiotics, it is important to speak with your doctor before taking probiotics, as they can interfere with the effectiveness of the antibiotics. Additionally, if you have a compromised immune system or suffer from chronic illness, you should consult your doctor before starting a probiotic regimen.
The Surprising Finding Was That The Group Who Received The Probiotic Had The Poorest Response In Terms Of Their Microbiome
As expected, a lot of major changes occurred in the function of the microbes many of which died because of the antibiotics, says Elinav.
The volunteers were divided into three groups. The first was a wait-and-see group, with no intervention after the antibiotics. The second group was given a common probiotic for a month. The third was given perhaps the least savoury option: a faecal transplant. This group had a small sample of their own stool taken before the antibiotic treatment returned to their colon once the treatment was over.
The surprising finding was that the group who received the probiotic had the poorest response in terms of their microbiome. They were the slowest group to return to a healthy gut. Even at the end of the study after five months of monitoring this group had not yet reached their pre-antibiotic gut health.
Probiotics won’t work exactly the same for everyone because gut biomes are different
We have found a potentially alarming adverse effect of probiotics, says Elinav.
The good news, incidentally, is that the group who received a faecal transplant did very well indeed. Within days, this group completely reconstituted their original microbiome.
So many people are taking antibiotics all over the world, says Elinav. We can aim to better understand this potentially very important adverse effect that we didnt realise existed.
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How Probiotics Support Gut Health
The balance of bad and good bacteria in your gut can be upset by medical conditions, physical stress, emotional stress, or the use of antibiotics â which are known to destroy bacteria.
Probiotics can tip the balance back to good bacteria. They can also boost your immunity, fight inflammation, and provide relief for painful digestion related to irritable bowel syndrome or infectious diarrhea.
Probiotic Benefits For Older People
Older people have naturally lower levels of good bacteria in the intestine, particularly those from the Bifidobacteria genus, which have been found to plummet by as much as 1,000-fold in individuals from 55 to 60 years old onwards1. This imbalance of good and bad bacteria in the gut is thought to significantly contribute to older people’s greater sensitivity to infections of the stomach and intestines.
You can read more about probiotics here.
At an older age, we can be more susceptible to health conditions including IBD, IBS, bloating, diarrhoea and indigestion all of which originate in the gut. Additionally, the natural deterioration of the immune system due to ageing, can cause negative changes in the gut microbiota of elderly people2.
Supporting the body’s balance of good bacteria can help maintain healthy digestion, a strong immune system, and overall vitality for all age groups – but perhaps, especially in the elderly.
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Probiotics And Antibiotics: An Overview
- Antibiotics deplete the populations of friendly bacteria in the gut and may cause digestive issues so its important to select probiotics to take with antibiotics, dont wait until the course has finished.
- If taking Lactobacillus acidophilus Rosell-52, Lactobacillus rhamnosus Rosell-11 and Bifidobacterium lactis Lafti B94 then take them with breakfast. These strains can be taken at the SAME time as your antibiotic if this is also at breakfast-time.
- If taking a different probiotic supplement, wait at least 2 hours after your antibiotics before taking probiotics.
- It is important to always follow the advice from your doctor, and always take and finish a course of antibiotics as prescribed. Taking probiotics alongside antibiotics may reduce digestive issues and enable you to finish a course, reducing the chances of antibiotic resistance.
- If you have already finished a course of antibiotics before being recommended a friendly bacteria supplement, better late than never by all means take a probiotic now! For next time, you know you can take them during as well as after.
- It simply isnt a question of antibiotics OR probiotics its a question of antibiotics AND probiotics.
You may also wish to read our FAQ, At what time should I take probiotics?
Effects On Different Mouse Models
As shown in Supplementary Table S1, there are other murine models that were successfully applied, one of them consisting of using D-galactose to induce premature senescence on Sprague Dawley rats. The results suggest probiotics ameliorated aging-induced metabolic diseases, pathogens growth, microbiota dysbiosis, oxidative stress, inflammation, and alteration of gut metabolites . In other works, the BALB/c strain was used, with or without D-galactose injection. Improvement of immunological markers , modulation of microbiota and protective effects on oxidative stress induced by D-galactose were reported with this model.
Finally, there are some other murine models used for specific studies. This is the case of Yang et al. , who used SAMP8 mice to study the potential of probiotics to treat deficits of the microbiota-gut-brain axis and cognitive function in aging. On the other hand, transgenic B6 mice were used to analyze the effects probiotics have on Alzheimers disease, showing promising results on the glucose metabolism and on the disease progression .
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Probiotics For Diarrhea: Benefits Types And Side Effects
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Probiotics are beneficial microorganisms that have been shown to offer a wide array of health benefits.
As such, probiotic supplements and probiotic-rich foods have become popular natural treatments for a number of health conditions, including digestive issues like diarrhea .
This article explains how probiotics may help combat diarrhea, reviews which strains are the most effective, and addresses the possible side effects associated with probiotic use.
The bacteria in your gut collectively known as the gut microbiota can be both negatively and positively affected by various factors, including diet, stress, and medication use.
When gut bacteria composition becomes imbalanced and the normal population of probiotics is disrupted, it can lead to negative health effects, such as an increased risk of conditions like irritable bowel syndrome and digestive symptoms like diarrhea .
The World Health Organization defines diarrhea as having three or more loose or watery stools in a 24hour period. Acute diarrhea lasts fewer than 14 days while persistent diarrhea lasts 14 days or longer .
Supplementing with probiotics may help prevent certain types of diarrhea and help treat diarrhea by repopulating and maintaining beneficial gut bacteria and correcting an imbalance.
Results Of The Search Excluded And Included Studies
The search retrieved 5,036 studies , of which, 15 articles were included . Fifty-six RCTs were excluded as there were oncological studies or included post-operative patients .
The included studies enrolled 5,916 participants from nine countries , with a mean age of 75.2 years and a median follow-up time of 319 days . Eight studies recruited inpatients , investigating the effect of probiotics on the prevention of CDD in three RCTs, patients were admitted from long-term care institutions evaluating respiratory tract infections ), and in four reports, participants were living in the community .
Eight reports enrolled only older patients , corresponding to 86.3% of the participants. The mean age in four out of the six remaining studies was greater than 65 years old one author provided non-published data on an older person , and in one report, the randomisation schedule was generated using a rule that included age at entry .
Two RCTs recruited solely functional dependent older participants one of them exclusively enrolled bed-ridden dementia patients. Three studies enrolled independent older patients , while most studies did not register functional capacity or cognitive status. No study used probiotics associated with prebiotics.
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What Makes A Good Probiotic
For a probiotic supplement to be useful it needs to have a few important factors included.
Firstly, the strains of microbes used in the probiotic supplement should be well researched with known beneficial effects. There is no point in eating bacteria that might have no effect or the effects of which are not known very well.
Secondly, there should be several different strains of microbes in a high-quality probiotic. This is because probiotics often work symbiotically and having several different strains improves the likelihood of colonizing your gut with a new beneficial bacteria strain.
Thirdly, there needs to be enough of all of the different microbes and they need to be stored in a biologically active way. There is no point in eating probiotic supplements that have only a little amount of the bacteria, especially if they are already dead.
High-quality probiotic supplements use manufacturing and storing methods that ensure there are millions of living organisms in one pill and the capsule is designed so that they can survive your stomach acid and actually reach your bowels.
Side Effects Of Probiotics
The common side effect of probiotics is increased digestive discomfort, such as bloating or gas. This is typically short-lived and resolves in a few days of regularly consuming probiotic supplements or probiotic foods.
More serious side effects are possible, but extremely rare. The bacteria or yeast that is consumed as a probiotic supplement can enter the bloodstream and cause infection. Those who are at increased risk of infection include immunocompromised patients, premature infants, those with short bowel syndrome, anyone with central venous catheters, and patients with cardiac valve disease.
It is, of course, important to discuss any supplementation with your healthcare provider.
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