‘The Stink’ on Probiotics: A Countermeasure Against Antibiotic Side-Effects

‘The Stink’ on Probiotics: A Countermeasure Against Antibiotic Side-Effects

Millions of people have to deal with the unpleasant side-effects of antibiotic use every year. Whether the side-effects manifest as minor stomach cramps or become something as unpleasant as antibiotic-associated diarrhea (AAD), the costs of using such medicines can be painful, to say the least. However, a new study in Vaccine has found that a regimen of probiotics taken in tandem with antibiotic treatments significantly reduce the chance of AAD and Clostridium difficile associated diarrhea (CDAD).  Researchers have verified these claims through conducting a randomized dose response study testing both  high-dose and low-dose strengths of a four-strain probiotic against a placebo on hospital outpatients who were prescribed antibiotics over the course of 10-21 days, depending on their regimen length.

The study took place in Changhai Hospital located in Shanghai, China. The 503 patients that volunteered for the study were hospitalized for varying diseases that required antibiotic therapy (167 using placebo, 168 using each probiotic treatment).  The study itself was conducted as a triple-blind, randomized dose-ranging analysis. HOWARU Restore was the chosen probiotic treatment to be administered once daily approximately 2 hours after breakfast and  each subsequent antibiotic dose. After the allotted study time, the average number of liquid stools went from 2.2 per day in the placebo group to 1.7 and 2.0 in the high-dose and low-dose group, respectively. Diarrhea duration was reduced from 5.4 days to 2.6 and 3.5 days in the high- and low-dose groups, respectively. Subjects also reported much less feelings of bloatedness while on a schedule of probiotic treatment.

The article had a great deal of information that was all presented in an extremely  organized way. The use of subheaders and the sections’ accompanying graphics really made the authors’ process of inquiry stand on its own. Confounding variables were foreseen by the instigators of the tests and were taken care of before they could have lasting effects on the results of the study. The study is remarkable in the fact that so many participants volunteered, and even after many were eliminated and a select few opted out, the resulting data was pooled from one of the largest subject bases in its field. Of the people that dropped out of the study, follow-up interviews with the subjects verified that what little probiotics they had taken still helped them combat diarrhea.  All relevant quantifiable data had a slough of statistical information to go along with it.Overall, the methods and presentation of the results were extremely organized.

The only shortcoming of the article was that it was often very numerically dense. At times, the amount of data that was presented was a little overwhelming, requiring more than one complete read-through. However, the quality of the research definitely makes the issue of quantity a little easier to slog through.

Various similar researchers have come to the same general consensus as this study has. Though some studies, like Hickson’s mentioned below, compare only a few different strains of probiotics, most tend to cover multiple strains. The articles from Johnston, Rand.org, and ScienceDaily.com all cover similar ground as our target study, lending to an even wider base of support for Ouwehand, et al.’s claims.

Antibiotic-associated diarrhea is a very common side effect of antibiotic use. If coupled with an effective probiotic, diarrhea and other common gastrointestinal upset symptoms can be largely reduced, if not avoided.  Though there is a considerable amount of data to support this claim, the paper that Arthur Ouwehand and his colleagues have submitted stand out, due to the fact that they have a fairly large pool of test subjects and a very organized structure. The only thing holding the paper back is the overwhelming numerical data that the reader must overcome to get to the meaning of the study. Readers should glean from this article that taking probiotic supplements in tandem with antibiotics often reduces the potential side-effects of such drugs. It also mitigates the effects that C. difficile can have on a patient’s elimination. Gastrointestinal fauna replenishment is an integral part of keeping your body healthy and functioning.


Hickson M, D’Souza A, Bulpitt C, et al. Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial. (Cover story). BMJ: British Medical Journal (International Edition) [serial online]. July 14, 2007;335(7610):80-83. Available from: Academic Search Premier, Ipswich, MA. Accessed February 22, 2015.

Johnston B, Ma S, Guyatt G, et al. Probiotics for the Prevention of Clostridium difficile-Associated Diarrhea. Annals Of Internal Medicine [serial online]. December 18, 2012;157(12):878-888. Available from: Academic Search Premier, Ipswich, MA. Accessed February 22, 2015.

Ouwehand A, DongLian C, Miller L, et al. Probiotics reduce symptoms of antibiotic use in a hospital setting: A randomized dose response study. Vaccine [serial online]. January 16, 2014;32(4):458-463. Available from: Academic Search Premier, Ipswich, MA. Accessed February 22, 2015.

Rand.org. Probiotics Can Reduce Risk of Diarrhea Caused by Antibiotics | RAND. 2012. Available at: http://www.rand.org/news/press/2012/05/08.html. Accessed February 22, 2015.

ScienceDaily. Can probiotics reduce severity of C. difficile infections?. 2015. Available at: http://www.sciencedaily.com/releases/2014/08/140807215529.htm. Accessed February 22, 2015.

Reviewed by Viktoriya Wolff

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