At one time, giving antibiotics to ill children was considered a normal part of life. A parent would bring a child to the physician's office, clinic or emergency room and leave with a prescription in hand, if only "just in case." However, this oft-used way to treat infections has become less accepted as a result of two rather unwanted side-effects. The first one is now universally known as the rise of antibiotic resistance. The other may not be well-known in the public but could be equally, if not more, sinister in nature.
Despite the benefits antibiotics provide in times of infection, they also come with the potential for side-effects. One of the most common is a form of gastrointestinal upset, officially known as antibiotic-associated diarrhea, or AAD. The ailment occurs as a result of a sudden loss of friendly bacteria known to help in proper digestion. In some trials, AAD has been shown to occur in as many as one in every three children given an antibiotic prescription.
But AAD isn't the only concern. In some cases, the troubles may end up getting worse as a result of Clostridium difficile. Best known as a pathogen of elderly people, this bacterium also can infect children and leave them with significant health troubles. Anyone who has been touched by this bacterial infection knows the troubles associated with this at times long-term condition.
The results suggest anytime an antibiotic is prescribed, a probiotic should be co-prescribed with it.
Because of the scourge of AAD and C. difficile, researchers have been trying to figure out how to best prevent these troubles. Over the last 10 years, one of the most successful -- and easiest -- routes has been the use of use of probiotics. When combined with an antibiotic prescription, these beneficial bacteria can help to reduce the chances for complications by limiting the disastrous effects of the antibiotic during treatment. In this light, the results suggest anytime an antibiotic is prescribed, a probiotic should be co-prescribed with it.
But while the data reveals significant improvement in the short term, the long-term benefit of daily intake of probiotics in the context of an antibiotic dose has not been fully examined. Considering probiotics are not sold as short-term therapies like pharmaceuticals, but rather supplements to be taken regularly, a proper investigation into their benefit has been sought, particularly in children.
Last week, that information finally became available. A Finnish group of researchers released the results of a three-year study examining the effects of long-term probiotic use on antibiotics and children's health. The results suggest probiotics may offer far more than a means to prevent AAD and C. difficile. They may actually help to reduce the need for antibiotics in the future.
The team worked with 501 children at the beginning of the study in 2009. They divided the children into two groups. One received a daily dose of a probiotic in milk (equalling about 500 million bacteria per day) while the other only had milk. The children were given the drink daily for a period of seven months from October to April.
The children were regularly contacted both during the intervention and afterwards until 2012 in order to learn if they had suffered from a gastrointestinal infection and also, if they had been given an antibiotic. The team collected this data and then tried to determine if there were any changes in health stemming from the probiotic intervention.
When the data was processed, there were a few expected differences between the treatment and control groups. Those who received the probiotic had fewer troubles with antibiotics in that seven-month period. The bacterial population also changed in those who took probiotic; the number of potential pathogens dropped.
There were, however, two surprises. The first was the inability of the probiotic to prevent the effects of a certain type of antibiotic, known as a macrolide. This particular chemical targets an essential function in bacteria and is relatively unstoppable unless resistance is present. The probiotic bacteria may live but they can only watch helplessly as other friendly species are killed.
The other surprise was much more pleasant for the researchers. During the three-year follow up, those who took the probiotic needed fewer treatments with certain antibiotics. In the case of macrolides, children who took the probiotic required half of the antibiotic prescriptions compared to those who only had the milk.
The highest difference was seen for an antibiotic called trimethoprim, in which kids who took the probiotic required only one-quarter of the number of prescriptions the control group needed during the intervention. The only antibiotic for which there was no difference in the number of prescriptions was penicillin.
This latter result revealed in part how the probiotic works over the long term to help maintain gastrointestinal health. When highly effective antibiotics are used, like macrolides and trimethoprim, the probiotic helps to ensure there is no chance for any survivors to regain a hold. However, when the antibiotic is not particularly effective, the probiotic is merely a bystander and stands by as strains with antibiotic resistance fight to maintain a hold on the intestinal tract.
This study offers yet another reason to think about including probiotics in one's daily life. The routine benefits offer enough reason but now, with this study, the idea of helping to reduce antibiotic use in children makes them even more attractive. The only caveat is to ensure the probiotic is one that has been tested. In this study, the species was Lactobacillus rhamnosus and as such, should be the only one considered to have this effect.
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Each of us has more than 1,000 different types of bacteria that live in our digestive tracts, helping us to break down food and absorb nutrients. But when we take antibiotics -- medicine that is designed to kill destructive, illness-causing bacteria -- the drugs can also kill the healthy intestinal flora that helps us digest. About 30 percent of the patients who take antibiotics report suffering from diarrhea or some other form of gastrointestinal distress, according to the recent JAMA study on probiotics and antibiotic-associated diarrhea. As a result, doctors commonly prescribe taking probiotics to "repopulate" the digestive tract with healthful bacteria. The study found that it was a viable solution for many. But probiotics can also help with other types of digestive issues. Research has shown that probiotics can be helpful for people with irritable bowel syndrome, or IBS -- a hard-to-treat condition that can have a range of intestinal symptoms, such as abdominal pain, cramps, bloating, diarrhea and constipation. In one study, female IBS patients experienced some alleviation of symptoms like abdominal pain and irregularity when they were given a supplement of the bacterial strain, Bifidobacterium infantis. Even for those without an urgent problem, probiotics can help with overall digestive management. Challa argues in his book, Probiotics For Dummies, that good bacteria help "crowd out" bad bacteria. That's because the intestine is lined with adherence sites where bacteria latches on. If the sites are populated with good-for-you microbes, there's no place for a harmful bacterium to latch on.
Probiotics make a nice compliment to antibiotics among people who suffer from urinary tract infections, according to the research. What's more, there's emerging evidence that regular probiotics can help prevent bad bacteria from invading the urinary tract by maintaining a population of healthy bacteria on the tract's adherence sites. Infections of the urinary tract are extremely common, especially in women. Most infections disappear with antibiotics, but about 30 to 40 percent might return, according to literature from the University of Maryland Medical Center.
Allergy research is still preliminary, but at least one large, high quality study found a relationship between women taking probiotics during pregnancy and a 30 percent reduction in the instance of childhood eczema (an early sign of allergies) in their infants. Researchers selected women who had a history of seasonal allergies -- or whose partners had histories of allergies. The infants who received probiotics in-vitro also had 50 percent higher levels of tissue inflammation, which is thought to trigger the immune system and reduce allergy incidence.
Just like the digestive tract, the vagina relies on a precarious balance of good and bad bacteria. When that balance is off, it can result in one of two very common, though thoroughly uncomfortable infections: bacterial vaginosis and yeast infections. In fact, bacterial vaginosis can actually lead to a yeast infection. Some small studies have found that L. acidophilius can help prevent infection, manage an already active one or support antibiotics as a treatment, though it's worth noting that the probiotics were taken as vaginal suppositories, rather than orally in food. Probiotics may also have a special role in maternal health, as pregnant women are particularly susceptible to vaginal infections. And bacterial vaginosis has been indicated as a contributing factor to pre-term labor, making probiotics a potential boon for fetal health.
Surprisingly, one of the main functions of healthful bacteria is to stimulate immune response. By eating probiotic-rich foods and maintaining good intestinal flora, a person can also help to maintain a healthy immune system. And that has real world effects: for example, in one small study of students, those who were given a fermented dairy drink (instead of milk) displayed increased production from lymphocytes -- a marker of immune response.
In 2006, Stanford University researchers found that obese people had different gut bacteria than normal-weighted people -- a first indication that gut flora plays a role in overall weight. Some preliminary research shows that probiotics can help obese people who have received weight loss surgery to maintain weight loss. And in a study of post-partum women who were trying to lose abdomnial fat, the addition of lactobacillus and bifidobacterium capsules helped reduce waist circumference. It's still unclear how probiotics play a role in weight loss -- and there is some controversy about how significant the probiotics-associated weight loss is. But as long as the probiotics source is low-calorie and healthful, itself, it is an innocuous method to attempt.
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