Don't do the Aztec two-step!

by Eric Robert Santiago on 07/23/12

Remember that first vacation to Cancun? Remember what a concerned friend told you about drinking the water there? Well, it may not be fair to sterotype the quality of the drinking water south of the border, but truth be told, we have all heard terrible stories about a friend or relative doing the Aztec two-step.

The use of prescription antibiotics are common place in the United States. The side effects of many antibiotic therapies, including antibiotic-associated diarrhea (AAD), can be difficult for patients to handle and may play a role in therapy compliance. Probiotics have proven time and again their benefits in gastrointestinal related disorders including AAD. A recent meta-analysis looks at the effectiveness of probiotic use while on antibiotics.

Probiotics are frequently used by patients on antibiotic therapy to lessen side effects, most notably AAD. We are often asked whether or not probiotics should be taken alongside antibiotic therapy or if patients should wait until after they have completed taking the antibiotic. Some doctors believe that patients should wait and "replenish" the gut after therapy because the antibiotic would likely kill the probiotic bacteria. Others believe that you should take probiotics with antibiotics because you are potentially lessening the side effects of the antibiotic. 

A recent meta-analysis in JAMA reviewed 82 randomized controlled trials examining the effects of probiotic supplements (mostly consuming of Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and/or Bacillus species) in the prevention and treatment of AAD. Of the 82 trials that were included, 63 reported the number of participants with diarrhea and the number of participants randomized to both treatment groups. Across these 63 trials, probiotic use was associated with a statistically significant lower relative risk of developing diarrhea compared with a control group not using probiotics. 

The pooled evidence from this meta-analysis suggests that probiotics are associated with a reduction in AAD and are beneficial to take during antibiotic use. Probiotics are a relatively inexpensive supplement that should be taken alongside any antibiotic to prevent AAD and in some cases C.difficle. 

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