Probiotic Interventions for Antibiotic-Associated Diarrhea

Antibiotic-associated diarrhoea (AAD) is a common complication of broad-spectrum antibiotic therapy, resulting from disruption of the indigenous gut microbiota. Probiotic interventions aim to restore microbial balance, enhance mucosal barrier function and attenuate inflammatory responses through mechanisms such as competitive exclusion of pathogens, modulation of host immunity and production of beneficial metabolites. Strain-specific efficacy has been demonstrated for several Lactobacillus and Bifidobacterium preparations, as well as the yeast Saccharomyces boulardii, highlighting the importance of precise microbial selection. Clinical outcomes range from reduced incidence and severity of diarrhoea to shorter duration of symptoms, although heterogeneity in trial design, dosing regimens and patient populations complicates direct comparison. Advances in formulation—such as encapsulation for targeted intestinal delivery—and combination approaches that include prebiotics or signalling molecules like autoinducer-2 promise to refine therapeutic effects. Globally, effective probiotic strategies offer a low-cost, safe adjunct to antibiotic regimens, with potential to lessen healthcare costs, limit nosocomial transmission of Clostridioides difficile and improve patient quality of life.

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Probiotic Interventions for Antibiotic-Associated Diarrhea publication trend

The graph below shows the total number of articles in probiotic interventions for antibiotic-associated diarrhea across all publications each year (not limited to Nature Index journals).

Technical terms

Antibiotic-associated diarrhoea (AAD): Diarrhoeal episodes occurring during or shortly after antibiotic therapy, often linked to microbiota disruption.

Dysbiosis: Imbalance in the composition or function of the gut microbiota, typically characterised by loss of beneficial bacteria and overgrowth of opportunistic pathogens.

Microbiota: The community of microorganisms, including bacteria, archaea, viruses and fungi, residing in a specific environment such as the human intestine.

Probiotic: A live microorganism which, when administered in adequate amounts, confers a health benefit on the host.

Prebiotic: A non-digestible substrate selectively utilised by host microorganisms to confer a health benefit.

Synbiotic: A combination of probiotics and prebiotics designed to synergistically improve microbial viability and activity.

Short-chain fatty acids (SCFAs): Metabolites such as acetate, propionate and butyrate produced by microbial fermentation of dietary fibres, important for colonic health.

Autoinducer-2 (AI-2): A universal quorum-sensing molecule used by diverse bacteria to regulate collective behaviours including biofilm formation.

References

1. A synbiotic mixture of selected oligosaccharides and bifidobacteria assists murine gut microbiota restoration following antibiotic challenge. Microbiome (2023).
2. Probiotic supplementation during antibiotic treatment is unjustified in maintaining the gut microbiome diversity: a systematic review and meta-analysis. BMC Medicine (2023).
3. Autoinducer-2 promotes the colonization of Lactobacillus rhamnosus GG to improve the intestinal barrier function in a neonatal mouse model of antibiotic-induced intestinal dysbiosis. Journal of Translational Medicine (2024).