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Abstract
BackgroundAntibiotic associated diarrhea and Clostridium difficile infection are frequent complications of broad spectrum antibiotic therapy. Probiotic bacteria are used as therapeutic and preventive agents in these disorders, but the exact functional mechanisms and the mode of action are poorly understood. The effects of clindamycin and the probiotic mixture VSL#3 (containing the 8 bacterial strains Streptococcus thermophilus, Bifidobacterium breve, Bifidobacterium longum, Bifidobacterium infantis, Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus paracasei and Lactobacillus delbrueckii subsp. Bulgaricus) consecutively or in combination were investigated and compared to controls without therapy using a standardized human fecal microbiota in a computer-controlled in vitro model of large intestine. Microbial metabolites (short chain fatty acids, lactate, branched chain fatty acids, and ammonia) and the intestinal microbiota were analyzed.ResultsCompared to controls and combination therapy, short chain fatty acids and lactate, but also ammonia and branched chain fatty acids, were increased under probiotic therapy. The metabolic pattern under combined therapy with antibiotics and probiotics had the most beneficial and consistent effect on intestinal metabolic profiles. The intestinal microbiota showed a decrease in several indigenous bacterial groups under antibiotic therapy, there was no significant recovery of these groups when the antibiotic therapy was followed by administration of probiotics. Simultaneous application of anti- and probiotics had a stabilizing effect on the intestinal microbiota with increased bifidobacteria and lactobacilli.ConclusionsAdministration of VSL#3 parallel with the clindamycin therapy had a beneficial and stabilizing effect on the intestinal metabolic homeostasis by decreasing toxic metabolites and protecting the endogenic microbiota from destruction. Probiotics could be a reasonable strategy in prevention of antibiotic associated disturbances of the intestinal homeostasis and disorders.
Highlights
Antibiotic associated diarrhea and Clostridium difficile infection are frequent complications of broad spectrum antibiotic therapy
Probiotics are promising agents in the prevention of associated diarrhea (AAD) and Clostridium difficile infection (CDI). They were used in the therapy of AAD and CDI and for regeneration of intestinal microbiota after antibiotic treatment
The probiotic product VSL#3 is a dietary supplement often used for treatment of various gastrointestinal complaints directly associated with microbial dysbiosis such as chronic constipation, diarrhea, flatulence, ulcerative colitis and pouchitis [16,26,27]
Summary
Antibiotic associated diarrhea and Clostridium difficile infection are frequent complications of broad spectrum antibiotic therapy. Antibiotic-associated diarrhea (AAD) and Clostridium difficile infection (CDI) are frequent complications of broad-spectrum antibiotic therapy. In a large prospective multicenter study, AAD was observed in 4.9% of the patients (1.8%-6.9%) receiving long-term antibiotic treatment with > 50% of patients showing positive testing for C. difficile toxin B [1]. The incidence of CDI is still increasing [2,3] and the disease is complicated by the Probiotics are promising agents in the prevention of AAD and CDI. They were used in the therapy of AAD and CDI and for regeneration of intestinal microbiota after antibiotic treatment. Reports state positive effect of probiotics on beneficial short chain fatty acid production and negative on harmful net ammonia production [12,13]
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