Indications for use and core problem
The main indication for prescribing microbiological preparations is dysbiosis. This condition can have a completely different etiology, but in pharmacological practice, special attention is paid to iatrogenic causes.
Most often, dysbiosis develops as a direct consequence of antibiotic therapy. The use of broad-spectrum antibiotics inevitably leads to the suppression of normal intestinal microflora, as the drugs destroy both pathogenic and beneficial microorganisms. Targeted drug intervention is required to correct this condition and return the intestine to a state of eubiosis.
Two-stage eubiosis restoration strategy
Dysbiosis therapy does not boil down to simply taking beneficial bacteria. It is a strictly sequential process divided into two interrelated stages: sanitation and reimplantation.
- Stage I — Sanitation. The duration of this period is 7 to 10 days. Antibiotics act as the pharmacological agents here. The goal of sanitation is the complete elimination of the pathogen causing dysbiosis, which is localized predominantly in the upper sections of the small intestine. The choice of a specific antibacterial drug at this stage is strictly individual and directly depends on the etiology of the identified disorder.
- Stage II — Reimplantation. This is a longer process, taking from 1 to 1.5 months. It is at this stage that microbiological preparations — probiotics — are introduced into the treatment regimen. Their main goal is the systematic colonization of the intestine with normal flora to replace the destroyed pathogenic flora.
Characteristics of reimplantation drugs
The pharmacological market offers a number of proven microbiological agents. The classic list of drugs for reimplantation includes:
- Colibacterin dry
- Bifidumbacterin
- Bificol
- Lactobacterin
- Bactisubtil
- Biosporin
- Gastropharm
The basis for creating these medicinal products is live cultures: Escherichia coli, bifidobacteria, and various bacilli. The end result of a course of these drugs is the successful colonization of the colon with saprophytic (beneficial to humans) bacteria. It is important to note that acidophilic microorganisms predominantly dominate among the engrafting flora.
Dosing principles and administration regimens
Methods for dosing probiotics directly depend on their biological basis. Pharmacology distinguishes two main approaches:
- In weight units. This method is characteristic exclusively of drugs created on the basis of bacilli (a typical example is Bactisubtil).
- In bacteriological doses. This method is used for the vast majority of other microbiological preparations.
The dosage regimen, namely the volume of a single dose, varies depending on the chosen agent. The minimum single dose starts from 2 doses (for example, when prescribing Gastropharm). The maximum single dose can reach 5–6 doses (such a regimen is typical for Bifidumbacterin and Lactobacterin). The standard frequency of oral administration is 2 to 4 times a day.
Combination therapy
To achieve the maximum therapeutic effect, probiotics are often used in combination with other substances.
- Combination with prebiotics. The most recommended combination is the concomitant intake of probiotics with lactulose. The goal of this combination is to create the most favorable environment in the intestinal lumen that will stimulate the active reproduction of eubiotic microorganisms (normal microflora).
- Combination with antibiotics. In clinical practice, there are situations when stopping baseline therapy is impossible. In such cases, continuation of antibiotic therapy directly against the background of probiotic intake is permitted.
Briefly: answers to topical questions
Which probiotics are dosed in weight units?
Probiotic preparations created on the basis of bacilli (e.g., Bacillus subtilis) are dosed in weight units. Unlike them, most other microbiological agents are measured in bacteriological doses.
- Bactisubtil is an example of a bacillus-based drug characterized by a weight-based dosing method.
A single dose of probiotics varies depending on the specific agent, ranging from a minimum of 2 doses up to a maximum of 5–6 doses per single intake.
What are the contraindications for the use of probiotics?
The provided materials indicate a situation when probiotics are not indicated:
- Bacterial food poisoning — probiotics are not indicated during the convalescence period.
Reason: non-inflammatory diarrhea develops in bacterial food poisoning.
Which drugs, besides lactulose, belong to the group of prebiotics?
In addition to lactulose, substances of non-microbial origin that stimulate the growth of one's own normal microflora belong to the group of prebiotics.
- Oligosaccharides — indicated as the chemical basis of prebiotics.
- Fructooligosaccharides — indicated as low-molecular-weight carbohydrates and the most studied prebiotics for constipation.
Prebiotics are not digested by human digestive enzymes, but are fermented by the intestinal microbiota and cause changes in the composition and/or activity of the GI microbiota, conferring health benefits.
To easily remember the two stages of dysbiosis treatment, use the rule "SR": First Sanitation (eliminate the pathogen with antibiotics), then Reimplantation (colonize the intestine with probiotics).
Class and exam questions
In which cases are patients prescribed probiotics?
The main indications are dysbiosis of any etiology, as well as pronounced suppression of normal intestinal microflora after a course of broad-spectrum antibiotic therapy.
Can probiotics be taken simultaneously with antibiotics?
Yes, clinical practice permits the continuation of antibiotic therapy while taking microbiological preparations to protect and restore the flora.
Why are probiotics combined with lactulose?
Lactulose acts as a prebiotic. Its main goal is to create a favorable nutrient medium in the intestine for the active reproduction of eubiotic microorganisms.
How long do drugs for flora restoration need to be taken?
The second stage of treatment (reimplantation) is a lengthy process. A continuous course of 1 to 1.5 months is required for full colonization of the intestine with saprophytic bacteria.
What else to study on this topic
- Mechanism of action of acidophilic bacteria in the colon
- Pharmacokinetic features of bacillus-based preparations
- Criteria for selecting an antibiotic for the small intestine sanitation stage
- Differences between bacteriological doses and weight units
- Interaction of probiotics and prebiotics in combination therapy
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