Synopsis

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

Lactobacillus is a genus of probiotic bacteria commonly used to support gastrointestinal health, especially during or after antibiotic therapy. The rationale for its use is grounded in scientific evidence, though the strength of that evidence is moderate and varies by specific strain and clinical outcome.

Antibiotics, while effective against pathogenic bacteria, can disrupt the gut microbiota, sometimes resulting in antibiotic-associated diarrhea (AAD) or Clostridioides difficile infection. Multiple randomized controlled trials and meta-analyses have investigated the use of Lactobacillus strains (often L. rhamnosus GG or L. casei) as adjunctive therapy. These studies generally show a reduction in the incidence of AAD compared to placebo, particularly in children. For example, a 2012 Cochrane review found that probiotics (many containing Lactobacillus) reduced the risk of AAD by approximately 50%.

However, evidence for using Lactobacillus as a true alternative to antibiotics (i.e., as an antimicrobial treatment in place of antibiotics) is lacking. Most studies focus on mitigation of antibiotic side effects rather than direct treatment of infections. Furthermore, not all strains are equally effective, and benefits are generally modest. Safety is generally good in immunocompetent individuals, but caution is advised in immunocompromised patients.

In summary, scientific evidence supports the use of Lactobacillus as an adjunct to reduce antibiotic-associated side effects, but not as a replacement for antibiotics in treating infections.

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