*For medical professionals only
Not necessarily
A doctor asks: Can probiotics be taken with antibiotics?
On this question, Jie Xiaoyao asked several pharmacists around her, and the answer was unexpectedly the same: No. The reason is that probiotics are living microorganisms and should not be taken at the same time as antibiotics, so as not to affect the efficacy.
Is it true?
“Expert Consensus on Pediatric Application of Probiotics” [1] pointed out that Saccharomyces boulardii, Clostridium butyricum and Bacillus are not sensitive to antibiotics and can be used simultaneously with antibiotics.
Meanwhile, Feng Donghua et al[2] isolated and cultured 20 strains of probiotics from 9 kinds of probiotic preparations in order to evaluate the in vitro resistance of common probiotics in the market to commonly used clinical antibiotics. The minimum inhibitory concentrations (MICs) of probiotics against 16 antibiotics were determined by concentration gradient test strip method (E-test).
Results show that bacterial probiotics are sensitive to some oral antibiotics, including Bacillus subtilis, Lactobacillus bulgaricus, Bifidobacterium longum, Bifidobacterium infantis and Streptococcus thermophilus is susceptible to more than 12 antibiotics.
E. faecium is only susceptible to 5 antibiotics, while fungal probiotics such as Saccharomyces boulardii CNCM I-745 are resistant to 16 antibiotics. This provides a reference for whether probiotics and antibiotics can be taken at the same time in clinical practice.
It can be understood that there are many varieties of probiotic preparations, and the same thing cannot be viewed with the same eyes. Looks like we need to rethink probiotics.
What are probiotics?
Probiotics refer to a certain amount of live microorganisms that can have a beneficial effect on the health of the host, and are a type of microecological preparations. Because probiotics are living microorganisms, many people think that antibiotics kill them.
Not really. There are two problems to clarify here, one is: living microorganisms are not just bacteria, and the other is: the concept of antibiotics must be clarified.
The difference between antibacterials and antibiotics:
Antibiotics: A class of chemicals that are produced by certain microorganisms in the process of life and have inhibitory or killing effects on certain other pathogenic microorganisms[ 3]. Antibiotics have a wide range of categories, including antibacterial drugs, antifungal drugs, antiviral drugs, and antitumor drugs.
Antibacterials: Antibacterials are medicines that inhibit or kill bacteria and are used to prevent and treat bacterial infections.
It can be seen that some antibiotics are designed to kill viruses, so maybe some probiotics are not sensitive to this antibiotic. Some antibiotics are designed to kill bacteria, so some fungal probiotics (such as yeast) are not sensitive to these antibiotics.
Classification of probiotics
The full name of probiotics is “beneficial active microorganisms”, mainly including yeast, probiotic spores, clostridium butyricum, lactobacillus, bifidobacteria, actinomycetes, etc.
According to the living conditions of the strains, it can be divided into anaerobic bacteria (Bifidobacterium, Lactobacillus, Clostridium, etc.), facultative anaerobic bacteria Bacteria (Escherichia coli, Enterococcus, Bacillus licheniformis, etc.) and aerobic bacteria (Bacillus subtilis, etc.).
Aerobic bacteria can consume oxygen, create an anaerobic environment for anaerobic bacteria, and promote the growth and reproduction of anaerobic bacteria. Aerobic bacteria and aerobic bacteria formulate each other.
In addition, according to the difference of strains, it can be divided into multiple live bacteria preparations and single bacteria preparations. At present, there are 36 probiotic preparations on the market in my country, 2 special medicines for children, 23 products containing single bacterial species, 4 products containing 2 species components, and 8 products containing 3 species components. In this product, there is only one Bifidobacterium quadruple viable tablet containing four kinds of bacteria [4].
Composite strains are more advantageous than single strains, because the compound strains can remain relatively stable and have greater buffering capacity and environmental adaptability in the human micro-ecological environment. Expert consensus [5] pointed out that for the rational application of microecological regulators, live bacteria preparations can be used alone, and the combined application of several live bacteria is recommended.
Appropriate use of probiotics
1
Combination
Except for Saccharomyces boulardii, Clostridium butyricum and Bacillus preparations, most probiotics are sensitive to antibiotics and should be used in combination with antibiotics at intervals of 2-3 hours. Probiotic preparations should not be used together with astringent adsorbent ingredients, such as montmorillonite powder, bismuth agent, activated carbon, etc.
2
Storage conditions
Except for the preparations of Bacillus licheniformis, Clostridium butyricum, Bacillus coagulans, and Bacillus subtilis, which can be stored at room temperature, other intestinal microecological preparations should be stored at low temperature, and be protected from light and sealed.
In addition, the probiotic preparation after opening has poor stability, and the contact between the live bacteria and the excipients and oxygen will lead to the death of the live bacteria and the oxidation of the excipients. Therefore, the package of the probiotic preparation can be opened only when taking it.
3
When to take
Stomach acid secretion is high when fasting, and probiotics are easily destroyed by gastric acid. It is best to take it 20 minutes after meals. The concentration of gastric acid decreases after meals, which is more conducive to allowing viable bacteria to reach the intestines smoothly. Play a role.
However, Saccharomyces boulardii powder can be taken at any time, but for quick results, it is best not to take it with food. In addition, probiotics should be taken with warm boiled water whose water temperature should not exceed 40 ℃, so as not to destroy the activity.
Common probiotic preparations in China[6]
References:
[1] Zheng Yuejie, Huang Zhihua, Liu Zuoyi, Wang Wenjian, Cheng Qian. Expert consensus on pediatric application of microecological preparations (October 2010) [J]. Chinese Journal of Practical Pediatrics, 2011, 26 ( 01):20-23.
[2] Feng Donghua, Zheng Zhongli, Lin Yongping, Fan Tingting, Jiang Yueting. Resistance analysis of probiotics to 16 antibiotics [J]. Chinese Journal of Microecology, 2021, 33 (10 ):1176-1180.
[3]Min Liyuan, Tan Yanxia, Ye Wenchun. Medicinal Chemistry: Yunnan University Press, 2012: 10-24.
[4]Zhao Zinan, Chen Li, Jin Pengfei, Li Kexin, Tian Chao, Hu Xin. Clinical research progress of probiotics [J]. China Pharmaceutical, 2021, 30(08): 96-102.
[5] Expert consensus on clinical application of microecological regulators in China (2020 edition) [J]. Chinese Journal of Microecology, 2020, 32(08):953-965.
[6] Chen Jie, Cheng Qian, Huang Ying, Huang Yongkun, Huang Zhihua, Lou Jin, Shu Sainan, Wang Baoxi, Wang Wenjian, Wu Qingbin, Zhang Lin, Zheng Yuejie. Clinical application of probiotics in pediatrics. [J]. Chinese Journal of Practical Pediatrics, 2017, 32(02):81-90.
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