Effect of adding probiotics to an antibiotic intervention on the human gut microbial diversity and composition: a systematic review

Abstract

Introduction. Millions of antibiotic prescriptions are written annually in the USA. Gap Statement. Probiotics reduce antibiotic-induced gastrointestinal side effects; however, the effect of probiotics on preserving gut microbial composition in response to antibiotics is not well understood. Aim. To evaluate whether the addition of probiotics is capable of reverting the changes in alpha diversity and gut microbial composition commonly observed in adult participants receiving antibiotics. Methodology. A search was conducted by two researchers following the PRISMA guidelines using PubMed, Science Direct, Cochrane and Embase from January to December 2021 with the following inclusion criteria: (i) randomized clinical trials assessing the effect of antibiotics, probiotics or antibiotics+probiotics; (ii) 16S rRNA; (iii) adult participants; and (iv) in English. Once data was extracted in tables, a third researcher compared, evaluated and merged the collected data. The National Institutes of Health (NIH) rating system was utilized to analyse risk of bias. Results. A total of 29 articles (n=11 antibiotics, n=11 probiotics and n=7 antibiotics+probiotics) met the inclusion criteria. The lack of standardization of protocols to analyse the gut microbial composition and the wide range of selected antibiotics/probiotics complicated data interpretation; however, despite these discrepancies, probiotic co-administration with antibiotics seemed to prevent some, but not all, of the gut microbial diversity and composition changes induced by antibiotics, including restoration of health-related bacteria such as Faecalibacterium prausnitzii . Conclusion. Addition of probiotics to antibiotic interventions seems to preserve alpha diversity and ameliorate the changes to gut microbial composition caused by antibiotic interventions.

A double-blind, randomized, placebo-controlled study assessing the impact of probiotic supplementation on antibiotic induced changes in the gut microbiome

“…A meta-analysis investigating the effects of probiotics during and post antibiotic treatment did not always support protective effects on diversity indices (E ́liaś et al, 2023), however the high variability of the studies means more research with similar probiotic strains and antibiotic types and durations is needed. By the end of the study, there was a significant spatial separation between the probiotic and placebo group which may provide further support for the probiotic playing a role in supporting the composition of the microbiota and this preservation of alpha diversity scores and reduced changes to gut microbial composition has been seen previously (Fernańdez-Alonso et al, 2022). The presence of Saccharomyces boulardii alongside the lactobacilli and bifidobacteria did not appear to have an observable impact on the alpha or beta diversities of the mycobiome.…”

Foundational Nutrition: Implications for Human Health

“…While not traditionally defined as nutrients, substantial evidence has emerged over the past two decades indicating the profound health effects of probiotics and probiotic-containing foods for promoting gut microbiome community diversity [ 150 ]. Recent data suggest that these multifaceted bacteria and their metabolites (short chain fatty acids, tryptophan metabolites such as indole, aryl hydrocarbon receptor ligands, polyamines, etc.)…”

Perioperative Nutritional Management in Enhanced Recovery after Bariatric Surgery

“…Can the handling of microbiota via prebiotics, probiotics and symbiotics provide benefits in pre-and postoperative phases, even taking into account that antibiotic treatments are mandatory for BS [91][92][93][94]? A recent systematic review shows that probiotics protect from loss of diversity and changes in gut microbial composition after intake of antibiotics [95] and American joint guidelines from different Scientific Societies support their role in cases of small intestinal bacterial overgrowth after BS [18].…”