Synopsis

Source of validity: Scientific
Rating (out of 5): 4

Lactobacillus species are widely used probiotics, and their use to counteract side effects of antibiotics—primarily antibiotic-associated diarrhea (AAD) and Clostridioides difficile infection—has substantial scientific backing. Numerous randomized controlled trials and meta-analyses have demonstrated that certain Lactobacillus strains (such as L. rhamnosus GG and L. casei) can significantly reduce the incidence and severity of AAD in both adults and children. The mechanism appears to involve re-colonization or preservation of the normal gut microbiota, production of antimicrobial substances, and competitive exclusion of pathogenic bacteria.

For example, a 2020 Cochrane review of 42 studies (over 11,000 participants) concluded that probiotics containing Lactobacillus species reduce the risk of antibiotic-associated diarrhea compared to placebo. Additionally, some evidence suggests that probiotics may reduce the risk of C. difficile-associated diarrhea, a particularly severe complication, though this effect is more pronounced in high-risk populations.

However, the evidence varies by strain, dose, and population. Not all Lactobacillus products are equally effective, and benefits are most clearly demonstrated with specific strains at appropriate doses. Probiotics are generally considered safe for most people, though caution is advised in severely immunocompromised individuals. In summary, there is solid scientific validation for using select Lactobacillus strains to mitigate certain antibiotic side effects, especially diarrhea.

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