PROBIOTICS

As a nurse you will have been asked about whether something is good to take or do.

Probiotics is one of those things.

The Mayo Clinic advises that probiotics are either the same or very similar to bacteria already present in the body. But not all bacteria in the body are “good”.

Having too may “bad” and not enough “good” bacteria may impact upon your body because of an unhealthy diet. The imbalance in bacteria can lead to weight gain, skin conditions, constipation and diarrhoea among many other chronic health problems.

Probiotics can be found in some yoghurts, some cheeses, diary products that contain probiotics, sauerkraut and kimchi. The most common bacterial strains of bacteria are the Lactobacillus species, Bifidobacteria, Saccharomyces boulardii and Bacillus coagulans.

On the surface, probiotics seem like a good idea to recommend to some patients. What’s not to like about something that has been shown to have such benefits?

Well, here’s the catch – not all probiotics are the same and nor do they have the same effects in the body.

One UK study led by Timothy Smith looked at recommending probiotics to reduce antibiotic use in people diagnosed with asthma. The study was to confirm a Cochrane review from 2011 that said that prophylactic probiotics significantly reduced Upper Respiratory Tract Infections (URTI), and antibiotic prescribing rates for these infections. However the Cochrane review only involved children. The UK study covered older children and adults.

The authors said

“Probiotic alone for preventing antibiotic use have not to our knowledge been evaluated in a prospective controlled trial”.

Acute respiratory tract infection is the most common reason for patient’s attending primary care facilities, and accounts for 80% of antibiotic prescriptions.

People with asthma are especially vulnerable to viral URTIs, which is a common trigger for acute asthma. This contributes to the use of unnecessary antibiotic prescription.

So this study tried a community-based intervention. It used advice leaflets that were sent out with influenza vaccination reminders that recommended taking a probiotics supplement daily through the winter months. The probiotics were available for free for up to six months. But they had to be asked for. Only 20% of patients used this option.

The study found that there was no significant difference in reducing the percentage of patients who received antibiotics. (27.7% for the intervention group compared to 26.9% for the control group).

The study authors stated that they

“found no evidence that the intervention of advice leaflets recommending probiotic supplementation ,with free access to such supplements, can reduce antibiotic prescriptions or promote improved respiratory tract health… Our data suggests that real-world use of probiotics to reduce winter infections and reduce antibiotic use cannot yet be recommended…”

The recommendation of the study authors urged further research as

“There is a need for new ways to prevent URTI and reduce antibiotic prescribing in asthmatic and non-asthmatic patients that are cost effective, safe and acceptable to patients.”

The upshot is that probiotics may be useful in some circumstances. In this instance, the use of prophylactic probiotics were not effective in patients with asthma and URTI.

To learn more about probiotics and asthma:

Mayo Clinic – What are probiotics?

Smith, Timothy DH, et al. “Recommending Oral Probiotics to Reduce Winter Antibiotic Prescriptions in People With Asthma: A Pragmatic Randomized Controlled Trial.” The Annals of Family Medicine 14.5 (2016): 422-430.

Hao, Qiukui, et al. “Probiotics for preventing acute upper respiratory tract infections.” The Cochrane Library (2011).