The Power Of Probiotics
It may seem strange: Youre taking antibiotics, so wouldnt probiotics undo the good your treatment is doing?
However, probiotics add helpful bacteria to your digestive system not the bacteria that cause infections. They dont have any effect on the antibiotic treatment. They only treat the side effects.
The thing that has really been shown to help the most with preventing diarrhea is taking probiotics when taking antibiotics, Dr. Rabovsky says. He notes that reviews of studies suggest probiotics are effective both for regular antibiotic-associated diarrhea and for diarrhea related to C. diff. They also seem to help with side effects such as cramping and gas.
Probiotics come in several varieties. The most commonly studied for antibiotic-associated diarrhea are Lactobacillus rhamnosus-based and Saccharomyces boulardii-based probiotics. Probiotics come in capsules, tablets, powders and even liquid form.
With so many options, be sure to ask your doctor for advice before taking any probiotics, as you should for any type of supplement. Probiotics could possibly be harmful for people with immune deficiencies or those who are severely debilitated.
Risk Of Bias In Included Studies
The risk of bias is categorized into three categories: high risk of bias, low risk of bias, and unclear. The individual studies results of the risk of bias assessment are shown in .
Risk of bias summary.
The quality of reporting was low 11 trials lacked adequate information to assess one or more of the parameters, thus making the risk of bias unclear. This was the case particularly regarding allocation concealment and blinding methods. For the blinding of participants, nearly half of the studies were evaluated as having a high risk of bias because the participants in the control group did not receive any kind of placebo matching the probiotic given to the intervention group.
Loss to follow-up was substantial in three trials . 11 studies did not perform an intention-to-treat analysis.
Visual inspection of the funnel plot for the primary outcome identified minor asymmetries for the smaller studies, but the relationship between the risk ratio and standard error did not appear substantially skewed, in turn suggesting that a possible publication bias is not likely to markedly affect the results.
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Restore Gut Health After Taking Antibiotics
- Eating foods that contain potassium can help replace it.
- Drink liquids, such as water, broths, or decaffeinated tea.
- Eating fruit such as bananas, applesauce, or small amounts of canned fruit without syrup
- Eating grains like white rice, white bread, and noodles
- Consume peeled potatoes boiled or baked
- Add protein sources such as poultry, lean meats, and fish to the diet
- Eating yogurt that contains live cultures
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Does Taking Probiotics Routinely With Antibiotics Prevent Antibiotic Associated Diarrhoea
- Accepted 27 October 2011
Diarrhoea develops in association with antibiotic treatment in 1% to 44%12 of cases, and ranges from mild episodes that resolve when antibiotics are stopped to serious complications such as toxic megacolon, bowel perforation, and death. Risk is increased with extremes of age, co-morbidity, oral broad spectrum antibiotics , prolonged antibiotic duration, previous antibiotic associated diarrhoea, and hospitalisation. Probioticslive microorganisms that, when administered in adequate amounts, confer a health benefit on the hostare present in products available in shops as foodstuffs, and in formulations used for specific therapeutic purposes. Probiotics are thought to combat antibiotic associated diarrhoea through restoring resistance to colonisation by pathogenic bacteria after the normal colonic microflora have been damaged by antibiotics, by breaking down non-absorbable compounds into absorbable products, by interfering with pathogenic toxins, and by enhancing immunity. Effects of probiotics vary by strain owing to differing resistance to gastric acid and bile, ability to colonise mucosa, and susceptibility to antibiotics.3
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Should You Take A Prescription
Your doctor may prescribe medicine to help control your symptoms if you often have diarrhea because of irritable bowel syndrome . These medicines include:
Rifaximin is an antibiotic that works on certain bacteria in your gut. Youâd likely only take it for 2 weeks. Itâs sometimes used to treat travelerâs diarrhea.
New IBS-D drugs are in the works. Ask your doctor if there are more options you can try.
Inflammatory bowel diseases, like Crohnâs disease or ulcerative colitis, can cause ongoing diarrhea. Your doctor will give you another kind of prescription to manage those conditions.
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Saccharomyces Boulardii Cncm I
Probiotics are living microorganisms that when administered in adequate amounts confer a health benefit.6 The single-strain yeast probiotic Saccharomyces boulardii CNCM I-745 is proven to help reduce the occurrence of antibiotic-associated diarrhea.6 For example, it has been demonstrated that the occurrence of diarrhea is reduced by 53% in adults when Saccharomycesboulardii CNCM I-745 is taken at the same time as antibiotics.6 In addition the yeast reduces the impact of antibiotics on the microbiota during treatment.7
Unlike bacterial probiotics, S. boulardii CNCM I-745 is naturally resistant to antibiotics which means that it can be taken at the same time as antibiotics to act on the immediate effect of the antibiotics on the microbiota and reduce the risk of antibiotic-associated diarrhea.8
Pay Attention To What You Eat
Would you like to get probiotics from food? Many types of yogurt contain probiotics. Look for active and live cultures on the label. It is advised to consume one or two plain Greek yogurts per day for patients consuming antibiotics. However, if eating dairy triggers stomach problems, go easy on dairy heavy foods while consuming antibiotics.
People who have more GI symptoms usually develop more GI side effects while consuming antibiotics, but each case is unique.
Foods that do not harm others may upset you, trust your gut. If spicy foods are usually cause you upset stomachs, avoid them when taking antibiotics. If sugar is your trigger, avoid sugary foods. Although fiber is usually important for digestion, you may need to decrease your consumption if your diarrhea flares up while you are taking antibiotics.
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When Is Diarrhea An Emergency
- Blood or pus in their poop
- Thrown up a lot
- Unable to keep food down
- More than six loose stools in one day
- Serious belly or rectal pain
- High fever
- Confusion or a dizzy feeling
National Institute of Diabetes and Digestive and Kidney Diseases : âTreatment for Diarrhea,â âDefinition & Facts for Diarrhea,â âSymptoms & Causes of Diarrhea.â
Cleveland Clinic: âDiarrhea: Management and Treatment,â âProbiotics.â
FamilyDoctor.org: âAnti-diarrheal Medicines: OTC Relief for Diarrhea.â
Mayo Clinic: âLoperamide ,â âBismuth Subsalicylate ,â âCurrent and future treatments for irritable bowel syndrome associated with diarrhea.â
Cureus: âLoperamide Overdose.â
DailyMed: âAnti-Diarrheal Loperamide HCL,â âKaopectate — bismuth subsalicylate tablet.â
FDA: âMedication Guide: Lotronex,â âFDA Drug Safety Communication: FDA warns about increased risk for serious pancreatitis with irritable bowel drug Viberzi in patients without a gallbladder,â âHow to Treat Diarrhea in Infants and Young Children.â
American College of Gastroenterology: âIrritable Bowel Syndrome.â
American Family Physician: âRifaximin for Irritable Bowel Syndrome,â âOver-the-Counter Medications in Pregnancy.â
KidsHealth.org: âReye Syndrome.â
Probiotics: Do No Harm
I want to posit an element of potential harm, and not rush in to recommend probiotics routinely in patients to whom you prescribe antibiotics.
I would also caution you not to use probiotics in patients in the intensive care unit, or in any patient with an indwelling prosthesis, particularly an intravascular prosthesis. There are reports of fungemia and bacteremia with probiotics, and the first rule is to do no harm.
A report that will come out soon in Clinical Gastroenterology and Hepatology describes a retrospective analysis of more than 12,000 hospitalized patients. Approximately 800 of these patients had received metronidazole for other indications before receiving broad-spectrum antibiotics. The investigators found an 80% reduction in C difficile infection in patients who had received metronidazole. This could be something to look at prospectively.
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Study Selection And Inclusion Criteria
In this review we chose to only include studies that had a clear definition of antibiotic-associated diarrhea, to be able to compare their results in a systematic way. However, studies lacking a precise definition of diarrhea may still provide valuable information, and it could be a subject for future discussions how to interpret them and whether to take them into account when formulating recommendations. Furthermore, the strict definition of diarrhea used in some studies means that the protective effect of probiotics against AAD may have been underestimated . Given the scope of the review, we searched for clinical trials involving the use of antibiotics, but we didnt apply strict inclusion criteria regarding the kind of antibiotic used. We didnt look for studies using specific treatments, nor did we exclude studies that did not indicate which antibiotics they used, since diarrhea can be a side-effect of many. Five of the studies that we included did not specify which antibiotic was administered to the patients during the clinical trial. Of the remaining 27 studies, 21 enrolled patients taking different antibiotics, including antibiotic such as broad-spectrum penicillins and cephalosporins associated with a high-risk of AAD.
Take With Or Without Food
Check the label on your antibiotics. Does it recommend taking them with food or on an empty stomach?
In either case, follow the directions. Some antibiotics are better absorbed on an empty stomach, so you dont want to limit their effectiveness. But if the label says, Take with food, taking your pills with a meal might help ease stomach issues.
Beyond the specifics above, good old-fashioned advice for treating diarrhea still applies. Drink plenty of water to avoid dehydration, and use rehydrating beverages high in electrolytes if needed. Avoid alcohol and caffeine if theyre making your diarrhea worse. Keep in mind alcohol may actually cause severe reactions while you are taking certain antibiotics, so check the label for that information, as well. Eat a more bland diet than you might normally eat.
Its better to use caution than get hit with unpleasant side effects.
Common sense would say you are going to disturb the natural balance with antibiotics, Dr. Rabovsky says, so anything else that causes you GI symptoms could make side effects even worse.
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Antibiotics Upset Intestinal Balance
Thousands of species of bacteria, yeast, and other microorganisms live on our skin, in our intestines, and on other body surfaces. Theyre known as our normal flora. When it is in balance, these microbes stay put and many of them contribute to good health. Bacteria in the gut, for example, help break down food.
Antibiotics kill these good microbes along with bacteria that are causing an infection. This upsets the balance of the normal flora in the intestines. The result is often loose, watery stools known as antibiotic-associated diarrhea.
The idea behind using probiotics is that they may help populations of good bacteria recover more quickly and restore order to the intestines. Theres no good evidence that probiotics are helpful in otherwise healthy people. But earlier research has suggested they can be helpful in:
- treating recurrent or persistent C. difficile colitis, when repeated courses of other therapies have not been successful
- preventing complications from pancreatitis
What To Expect From Your Doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover other points you want to address. Your doctor may ask:
- When did your symptoms begin?
- Can you describe your bowel movements? How frequent are they?
- Do you have a history of intestinal problems such as ulcerative colitis, Crohn’s disease or other inflammatory bowel disease?
- Have you been around anyone with diarrhea recently?
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Safety Of Probiotic Use
Examining available data for adverse events of probiotics is not an easy task it is mostly under-reported in the literature. In their trial, Allen et al found a statistically significant difference in flatus in the probiotic group. Almost 20% of participants had serious adverse events, but the frequency was similar in both groups. The most common were respiratory, mediastinal and thoracic disorders . In the 2012 review performed by Johnston et al, 17 RCTs reporting on side effects were assessed. Four reported no adverse events at all and three reported serious ones. However, the frequency of events was higher in the control group . The most commonly reported symptoms were abdominal cramping, nausea, fever, soft stools and flatulence. When Pattani et al performed their meta-analysis they found no life threatening adverse effects in the 16 RCTs studied. Furthermore, one of the largest meta-analyses to-date assessing probiotics is the one performed by Hempel et al in 2012 it included 84 RCTs, of which 59 did not report on probiotic-specific adverse events. The rest did not mention any serious side effects. More importantly, three recent systematic reviews have addressed the safety of probiotics. The most comprehensive of them searched 12 electronic databases they included 208 RCTs. For short-term probiotic use compared with the control group there was no statistically significant difference in the overall number of adverse events including serious ones .
Ways To Prevent Diarrhea While Taking Antibiotics
1. Take Probiotics While Taking Antibiotics
Contrary to popular belief, its now becoming more widely known that taking probiotics while taking antibiotics as opposed to beginning them afterward can be extremely helpful in preventing diarrhea.
A high-quality probiotic supplement works by delivering beneficial bacteria to the gut. As many antibiotics can wipe out good bacteria in addition to the bad, probiotics can help to repopulate the good bacteria that has been wiped out by the antibiotic. Studies suggest that taking probiotics during the course of your antibiotics and after can help to prevent and alleviate antibiotic-associated diarrhea.
2. Eat Fermented Foods
On the subject of probiotics, eating naturally fermented foods before and during your course of antibiotics can also help to lessen your chances of suffering from diarrhea. Fermented foods are rich in probiotics, and include delicious options such as raw sauerkraut, kimchi, kombucha tea, miso and kefir. If youre new to fermented foods, begin slowly and work your way up.
3. Eat the Right Foods
Avoid foods high in sugar, artificial sweeteners and refined grains, as these can cause or worsen diarrhea. Enjoy nourishing and gut-supporting foods like homemade broths and soups, cooked vegetables and small amounts of lean protein.
4. Avoid Alcohol
5. Stay Hydrated
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Are There Other Ways To Treat Diarrhea
A probiotic may help. Theyâre pills or food with âgoodâ bacteria or yeast in them. They can replace âbadâ bacteria that live in your gut. More research is needed to know if they soothe diarrhea. Ask your doctor if theyâre right for you.
Not eating foods you have a hard time processing may stop diarrhea. If youâre not sure what to avoid, talk to a registered dietitian nutritionist . They can help you figure out the problem foods.
Diarrhea After Antibiotics Here’s How To Get Back On Track
There are many reasons you might be prescribed antibiotics, like to treat strep throat, a urinary tract infection or even a sinus infection. And while these types of drugs typically clear things up and help you feel better fast, they can leave you with a particularly unwelcome side effect: diarrhea.
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“In your bowels, there are billions of bacteria, which help digest food and keep you regular,” Charles Kistler, MD, a gastroenterologist with Jefferson University Hospitals in Philadelphia, tells LIVESTRONG.com. “Taking antibiotics will help fight the infection but the collateral damage is that they can kill some of the good bacteria, and therefore alter the balance of microbes in your gut.” This change in bacterial balance can lead to diarrhea, he says.
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What Foods Should You Eat To Treat Diarrhea
If youre experiencing diarrhea from antibiotics, adjusting your diet may help ease your symptoms. Some general suggestions include:
- Eating low fiber foods. While high fiber foods are recommended when youre healthy, eating them when you have diarrhea can make your condition worse.
- Replacing potassium. This nutrient can be lost due to diarrhea, but eating foods containing potassium may help replace it.
- Replenishing lost fluids and salts. Diarrhea can cause you to lose fluids and electrolytes more rapidly, so its important to replace these.
Based on these suggestions, try to consume the following foods and beverages when you have diarrhea:
- fluids including water, broths, or decaffeinated tea
- fruit such as bananas, applesauce, or small amounts of canned fruit without syrup
- grains such as white rice, white bread, and noodles
- peeled potatoes that have been boiled or baked
- protein sources like poultry, lean meats, and fish
- yogurt that contains live cultures
Some types of food may worsen your symptoms or interfere with your antibiotic treatment. These include:
Also, try to avoid eating grapefruit or taking calcium supplements. These can both interfere with how well antibiotics are absorbed by your body, and can diminish the effects of the medication.
In addition to adjusting your diet, there are other steps you can take to help ease your symptoms.
Consider Some Otc Help
You might also ask your physician about taking the over-the-counter anti-diarrhea medication loperamide , which works by decreasing fluids that flow into your colon and slowing down the movement of your gut, prompting fewer poops, according to the U.S. National Library of Medicine. If you have certain underlying health conditions, your doctor might advise against this type of medicine Dr. Kistler says, so always check with them first.
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