Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Lactobacillus (mixed species) is commonly used as a probiotic adjunct to support or restore gut health during and after antibiotic therapy. Scientific evidence suggests that antibiotics can disrupt the natural gut microbiota, leading to side effects such as antibiotic-associated diarrhea (AAD) and increased susceptibility to opportunistic infections, most notably Clostridioides difficile infection. Several randomized controlled trials and meta-analyses have demonstrated that supplementation with certain mixed Lactobacillus strains—sometimes in combination with other probiotics—can reduce the risk and severity of AAD in both adults and children. The proposed mechanism involves recolonization and restoration of the healthy gut flora, competition with pathogenic bacteria, and modulation of the immune response. However, the degree of benefit may vary depending on the specific strains used, dosage, and patient population. It is important to note that while Lactobacillus probiotics are not a direct alternative to antibiotics in treating infections, they are used as a supportive measure to mitigate the adverse effects of antibiotics. The overall quality of evidence is moderate (rated 3/5), with some variability in the results of clinical trials and limited high-quality data for specific patient groups or infection types. Clinical guidelines from several health organizations recognize the potential benefit of probiotics, including Lactobacillus mixtures, for preventing AAD, but do not recommend them as replacements for antibiotics in treating bacterial infections.

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