Probiotics and Antibiotic-Related Effects on the Microbiome – do they help?
Review by Mr. Cass Condray (USA)
Study Summary
Probiotics have long been proposed as restorative treatments for the gut microbiota after courses of antibiotics, with the aim of preventing dysbiosis and infections such as C. diff and H. pylori. However, these benefits may not be clinically significant.
Antibiotic use exerts disruptive effects on the gut microbiota, and, as a consequence, is associated with increased risk of infections such as Clostridioides difficile (C. diff) diarrhea and C. diff infection (CDI). Previously, it was assumed that consumption of probiotics and probiotic supplementation during and following antibiotic treatment could decrease the risk of this dysbiosis and related gastrointestinal infections. In this comprehensive and critical review, Szajewska and colleagues provide a comprehensive assessment of the available literature on the impact of antibiotics on the gut microbiome and the potential of probiotics to ameliorate antibiotic-related disruptions. They noted that studies of the impact of probiotics in the aftermath of antibiotic treatment are compromised by a failure to account for factors that can influence outcomes, such as the specific strain and dose of the probiotic(s) administered, as well as host characteristics, such as genotype and baseline microbiome. Lack of consistency in the methodology used to document microbiota recovery and in microbiological as well as clinical end points also confound interpretation and inter-study comparability.
Furthermore, these authors document that, while antibiotics exert profound impacts on microbe abundance in the short term, microbial communities in the gastrointestinal tract exhibit considerable plasticity and resilience in the long-term making the restorative impacts of probiotics in the short term of questionable significance.
Commentary
This important review emphasizes the long-term resilience and stability of gut microbiota and underlines the confounding impacts of factors such as diet, geography and human genotype on microbiome recovery following perturbation. A failure to account for these, as well as other factors, limits the interpretability of available probiotic studies in this context and renders it difficult to make recommendations on probiotic use for any given individual. Pending the performance of high-quality clinical trials that account for the aforementioned limitations, the body of evidence to support probiotic supplementation to prevent antibiotic-associated diarrhea and infections such as C. diff is not sufficiently substantive and, overall, shows no significant benefit.
Citation
Szajewska, H., Scott, K.P., de Meij, T. et al. Antibiotic-perturbed microbiota and the role of probiotics. Nat Rev Gastroenterol Hepatol 2025;22:155–172. https://doi.org/10.1038/s41575-024-01023-x
https://www.nature.com/articles/s41575-024-01023-x#citeas
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