- 4 Conditions Probiotics Are ly to Treat
- Could probiotics replace antibiotics in wound healing?
- Risks and Benefits of Probiotics
- Probiotic use may reduce antibiotic prescriptions
- Probiotics: Possible side effects and how to take them safely
- Digestive symptoms
- Skin problems
- Allergy risk
- Increased risk of infection
- Small intestine bacterial overgrowth (SIBO)
- Antibiotic resistance
- Take Probiotics to Fight Off Yeast and Bacteria Infections
- Oral probiotics can resolve urogenital infections
- 2.1 Probiotic bacteria
- 2.2 Patients and methods of delivery and recovery of the lactobacilli
- 3 Results
- 4 Discussion
- Probiotics and Antibiotics Create a Killer Combination
4 Conditions Probiotics Are ly to Treat
The trillions of bacteria and yeast found in the intestinal tract are one of the hottest topics in medicine. So it's no surprise that probiotics, and foods or supplements containing live organisms that can help maintain a normal balance of good and bad bacteria in the gut, have also gained more attention.
“There's been a tremendous increase in interest in probiotics among practicing physicians and the general public,” said Dr. Allan Walker, a professor of pediatrics at Harvard Medical School and an investigator at the Mucosal Immunology and Biology Research Center at MassGeneral Hospital for Children in Boston.
“Over the last 10 to 15 years, research into probiotics and intestinal microbes has taken off, and many talented researchers have entered the field,” Walker said. [5 Ways Gut Bacteria Affect Your Health]
In his own research, Walker studies the use of probiotics in infants, and has also co-chaired the Yale Workshop, a group of experts who analyzed the scientific data and published recommendations for physicians on probiotic use in 2011. The group will meet again to review the latest evidence and release updated guidelines in March 2015.
Although the interest in probiotics is skyrocketing, the medical community is not as excited about probiotics as the public, because doctors want to have strong scientific evidence before making recommendations for patients, Walker told Live Science. What's really needed to move the science ahead is to gather more evidence from multiple-center clinical trials, he said.
So far, results from studies have been mixed, with some researchers finding that probiotics are beneficial for health and others finding no benefit. There are four conditions that Walker said currently have the strongest positive evidence to support their use.
There's solid evidence, in both children and adults, that giving probiotics to people when they start on a course of antibiotics may help prevent diarrhea, a common side effect of taking these drugs. Antibiotics can wipe out both good and bad bacteria in the gut, disturbing the normal intestinal balance and resulting in diarrhea in as many as 30 percent of people receiving treatment.
Probiotics can help replenish the good strains of bacteria and restore intestinal balance.
“It takes a long time for the intestines to recover from taking antibiotics,” Walker said. For this reason, he suggests that patients continue on probiotics for a month after they finish taking antibiotics.
Two of the best-studied probiotic strains for antibiotic-associated diarrhea are the yeast Saccharomyces boulardii and Lactobacillus GG.
Infectious childhood diarrhea
There's solid data supporting the use of probiotics to help treat infectious diarrhea in young children, especially diarrhea caused by rotavirus, a bug spread easily in babies and young children, Walker said.
Rotavirus is a common infection among children attending day care that can quickly spread when toys, surfaces and hands become contaminated with the virus. Infected children may have severe diarrhea, fever and stomach pain, and are at risk for becoming dehydrated.
Research has found that when probiotics are used as a treatment to ease symptoms of the virus, they may shorten the duration of diarrhea and its frequency by about a day.
Lactobacillus GG is the best-studied strain.
Inflammatory bowel disease (IBD)
Ulcerative colitis, one type of inflammatory bowel disease that affects the lining of the large intestine, appears to be more responsive to probiotics than the other main type of inflammatory bowel disease, Crohn's disease. A flare-up of ulcerative colitis, an autoimmune disease, produces symptoms including frequent, and often bloody, diarrhea; abdominal pain and cramping; and weight loss.
The strongest evidence for the use of probiotics in ulcerative colitis shows that probiotics should be taken once a person has been brought into remission, Walker said. Research has found that people who take probiotics at that point can sustain remission for longer, perhaps for as much as six months to one year, compared with individuals not taking a probiotic, he said.
For people with ulcerative colitis, probiotics seem to work better behind-the-scenes, almost as a preventive measure, rather than as a treatment taken during the inflammatory, flare-up phase of the condition, Walker said. The most effective strains are Escherichia coli Nissle (which is not a harmful strain of E. coli), and VSL#3, which is a probiotic containing eight bacterial strains.
This condition involves inflammation of the lining of the intestines, and can occur following surgery to remove large portions of the colon in people with severe ulcerative colitis. Pouchitis can affect up to 50 percent of people who undergo this surgery, which replaces the diseased colon by creating an internal pouch with the ileum, the lowest portion of the small intestine.
the colon, this pouch can become a reservoir for bacteria, Walker said. To sustain remission of pouchitis, patients are often given a “cocktail of antibiotics,” he said.
Studies suggest that taking probiotics following surgery might help prevent pouchitis, and also maintain remission of the disease after treatment with antibiotics. The most helpful strain appears to be VSL#3.
Follow us @livescience, & . Original article on Live Science.
Could probiotics replace antibiotics in wound healing?
The microbiome is known to play a major role in gut health, but what about our skin? Billions of bacteria reside there, and the probiotic types may hold great potential to prevent infections during wound healing.
Our skin provides a natural barrier to the environment. This is crucial for our health, as skin protects us from invasive pathogens such as bacteria and viruses.
When the skin barrier is damaged, these pathogens are ready to make their way into the body to colonize it. This is particularly dangerous if the bacteria in question cause widespread damage to skin or other tissues, and if they are resistant to antibiotics.
Staphylococcus aureus is naturally present in the noses of around 30 percent of the population and mostly does not cause harm. However, when the skin barrier is broken, S. aureus can cause severe infection.
S. aureus is notorious for forming biofilms. When this happens, the bacteria attach to a surface – such as the skin – and sugar molecules form a protective matrix around the bacteria. Biofilms are mostly resistant to antibiotics and are therefore a considerable health risk.
If S. aureus spreads to the blood it can cause sepsis, which is a major cause of death in children who have experienced severe burn injuries.
Pseudomonas aeruginosa, which is another pathogen known to form biofilms, is often found in infected burn wounds. Normally resident in the gut, this pathogen invades and colonizes the skin – followed by other organs such as the liver and lungs – in immunocompromised individuals such as burn patients.
Although antibiotics are used in wound treatments, multidrug resistance is common and infections persist. Scientists are searching for alternatives. Could bacteria provide much-needed strategies to prevent life-threatening infections?
Do bacteria have antibacterial properties? Yes, they do; they naturally compete with each other for living space and food. To achieve this, bacteria produce antimicrobial molecules that specifically prevent the growth of other bacteria by altering the growth environment in their favor and by disrupting communication between other bacterial cells.
Catherine O’Neill, Ph.D. – senior lecturer in the Division of Musculoskeletal and Dermatological Science at the University of Manchester in the United Kingdom – and her team have tried to harness these properties by using bacteria to prevent pathogen infections.
But does skin harbor suitable bacteria? In response to that question, Dr. O’Neill told Medical News Today, “We really don’t have any idea of skin probiotics. We don’t know enough about the skin’s microbiome and how it interacts with the wound.”
Instead, she uses lactobacillus bacteria, which are a group of so-called friendly bacteria, in her research. Lactobacilli are mostly harmless and some strains are a crucial component of our daily lives in that they facilitate the fermentation of products such as yogurt, beer, and wine.
Dr. O’Neill’s team showed that both L. rhamnosus GG and L. reuteri could protect skin cells in the laboratory from infection by S. aureus. This was true when live bacteria were added to the skin cells and when the bacteria were killed and their extracts added instead.
In a recent study published in the journal Scientific Reports, Dr. O’Neill further showed that the two lactobacilli had different effects on skin cells in a wound healing model.
L. rhamnosus GG mostly promoted cell migration, allowing the cells to close the artificial wound rapidly, while L. reuteri increased rates of cell division, helping to replenish the pool of cells destroyed by the creation of the wound. This study used bacterial extracts rather than living cells.
Dr. O’Neill told MNT that she sees bacterial extracts as a safer way to treat patients because there are incidences when lactobacillus bacteria have entered into the bloodstream of immunocompromised patients and caused harm.
“I doubt you’d get any clinician to put live bacteria onto a wound [in the U.K.],” she explained. “We’d have a lot more success getting a dead organism through ethics committees.”
A handful of studies have gone further and tested the effects of probiotics in mouse models of burns and wound healing.
Susan E. Erdman – assistant director in the Division of Comparative Medicine at Massachusetts Institute of Technology in Cambridge – and her team looked at the effect of adding probiotics to the diet of mice on wound healing.
Their study, published in PLOS One, showed that feeding L. reuteri to mice resulted in an increase in oxytocin, which is a hormone important in reproduction, childbirth, lactation, and social behavior.
Interestingly, the increase in oxytocin was accompanied by a faster rate of wound healing in older mice. Their wounds closed twice as fast as those of control mice.
In a study published in Clinical Microbiology and Infection, Juan Carlos Valdéz, Ph.D. – from the National University in Tucumán in Argentina – and colleagues showed that L. plantarum can inhibit the growth of P. aeruginosa both in vitro and in a mouse model of burn wound healing.
Sandeep Kathju, M.D. – an associate professor in the Department of Plastic Surgery at the University of Pittsburgh School of Medicine in Pennsylvania – and colleagues investigated the effect of L. plantarum on P. aeruginosa-induced sepsis in a mouse burn model.
The study, published in PLOS One, showed that in 12 13 mice, L. plantarum prevented sepsis and did not have any detrimental effects on burn wound healing.
But while these studies in mice are encouraging, is there any evidence in humans?
Dr. Valdéz and colleagues performed a small study with eight patients in the Plastic Surgery and Burns Unit at Hospital Centro de Salud ”Zenón Santillán” in Tucumán, Argentina.
These patients had a mix of second- and third-degree burns, and the team found that L. plantarum was as efficient as silver sulphadiazine, a commonly used antimicrobial, in preventing and reducing burn wound infections.
Richard J. Kagan, M.D. – a professor of surgery at the University of Cincinnati College of Medicine in Ohio – and colleagues reported the results of a clinical study on pediatric burn patients in the Journal of Burn Care & Research. This study included 20 children, half of whom received a probiotic and half of whom were treated with a placebo.
The mean age of the patients was around 7 years, and the treatment was administered daily, starting 10 days after their initial burn and lasting until their wounds were closed.
The wounds of patients treated with probiotics healed at a faster rate than those of patients treated with a placebo.
these studies, why are probiotics not commonplace in clinics around the world? It’s a question of numbers.
Baljit Dheansa – lead surgeon for burns at Queen Victoria Hospital in East Grinstead, U.K. – told MNT, “It’s interesting to hear about these probiotics but to date there has been very little robust evidence to show that they have a significant effect in general, though there are many anecdotal reports. In relation to wound healing, I think there is even more doubt.”
“If probiotics are to usefully enter the wound healing arena we need to make sure that we conduct well-constructed research studies that will help us establish a proper evidence base for their use in real wounds in humans rather than in the lab.”
But in the face of multidrug-resistant bacteria posing a real threat to human health, alternatives to classic antibiotics are desperately needed.
In fact, P. aeruginosa is on the World Health Organization’s (WHO) list of critical pathogens for which new antibiotic treatments are urgently needed, closely followed by S. aureus, also listed as a high priority.
Dr. O’Neill also commented that wound healing was a clinical area that is “desperate for some innovation,” but what is the lihood of a commercial company investing in costly clinical trials to develop probiotics for wound healing?
Dr. O’Neill thinks that “commercially it could be extremely successful,” especially as the bacterial lysates that she works with are not expensive to produce. For now, though, treatment with probiotics remains the prerogative of the physician and the healthcare setting.
In a report published in the Journal of Wound Care, Kenneth Dunn – a consultant burn and plastic surgeon at University Hospital South Manchester in the U.K. – and colleagues used a popular probiotic yogurt drink to treat a patient with extensive burn wounds and a multidrug-resistant P. aeruginosa.
The bacteria had populated both the skin and the gut, and the team thought that the gut was acting “as a reservoir for re-infection.” Within 2 weeks of treatment, the P. aeruginosa population had changed from multidrug-resistant to drug sensitive, allowing the team to successfully eradicate the patient’s infection.
With our increasing knowledge of the importance of the microbiome for health, there is a chance that bacteria – or their extracts – will one day successfully join the fight against their pathogenic cousins, thereby keeping deadly skin infections at bay.
Risks and Benefits of Probiotics
- How Probiotics Are Good for You
- How Probiotics Might Be Bad for You
Probiotics are a type of “good” bacteria found in some foods and supplements. We usually think of bacteria as something that can cause diseases or other problems. But probiotics can help keep your gut healthy.
Your body doesn't need probiotics. You already have healthy bacteria in your gut. But it usually doesn't hurt to take them, and adding them to your diet might help.
They might lower the number of “bad” bacteria in your gut that can cause illness or inflammation. They can also replace those problem germs with good or helpful bacteria.
Researchers are studying when and how probiotics might best help. There's more research for some illnesses than others. They might help people with:
- Diarrhea , especially when it's linked to specific antibiotics. Probiotics also might help with infectious diarrhea, especially in children.
- Inflammatory bowel diseases (IBD) including Crohn's disease and ulcerative colitis. Some probiotics might keep ulcerative colitis in remission (a state of little to no disease activity) and prevent Crohn's disease from relapsing and getting worse.
- Irritable bowel syndrome . Probiotics can sometimes help ease symptoms, including stomach pain, bloating, gas, diarrhea, and constipation.
Probiotics also are being studied for many other conditions. There isn’t as much research yet, but some people say that probiotics have helped them with:
Because these good bacteria already exist in the body, they’re considered safe for most people. But there are some things to consider.
They can trigger an allergic reaction. They might cause mild stomach problems, especially the first few days you start taking them. You might have stomach upset, gas, diarrhea, or bloating. Those symptoms usually go away after your body gets used to them.
If you have an immune system problem or another serious health condition, you may have a greater chance of issues. Some reports have linked probiotics to serious infections and other side effects.
The people most ly to have trouble are those with immune system problems, people who've had surgery, and others who are critically ill. Don't take probiotics if you have any of those issues.
Always talk to your pediatrician before giving probiotic supplements to your child. If you're pregnant or nursing, you should also talk to your doctor before you try one.
Most probiotics in the U.S. are sold as dietary supplements. That means the companies that make them don't have to test their products and show that they work or that they are safe. More research is needed to confirm that probiotics are safe and effective.
Ask your doctor which probiotics are the right ones for you. Be sure to stop taking them if you have any problems.
National Center for Complementary and Integrative Health: “Probiotics: In Depth.”
Cleveland Clinic: “Probiotics.”
University of Florida IFAS Extension: “Commonly Asked Questions about Probiotics and the Potential Benefits for Your Health.”
Harvard Health Publications: “Health benefits of taking probiotics.”
Mayo Clinic: “Do I need to include probiotics and prebiotics in my diet?”
Arthritis Foundation: “The Promise of Probiotics for Arthritis.”
© 2019 WebMD, LLC. All rights reserved.
Probiotic use may reduce antibiotic prescriptions
Use of probiotics is linked to reduced need for antibiotic treatment in infants and children, according to a review of studies that probed the benefits of probiotics, say researchers in the U.S., England and the Netherlands.
Their study, supported in part by the International Scientific Association for Probiotics and Prebiotics and published in the European Journal of Public Health, found that when the results from twelve studies were pooled together, infants and children were 29% percent less ly to have been prescribed antibiotics if they received probiotics as a daily health supplement. When the analysis was repeated with only the highest quality studies, this percentage increased to 53%.
The findings are very intriguing, the researchers say. “Given this finding, potentially one way to reduce the use of antibiotics is to use probiotics on a regular basis,” says the study's senior investigator, Daniel Merenstein, MD, a professor in the Department of Family Medicine at Georgetown University School of Medicine. He is also director of research programs in the department.
According to the Centers for Disease Control and Prevention (CDC), there are about two million cases of antibiotic resistant infections yearly in the U.S., resulting in 23,000 deaths. Reducing the use of antibiotics is one strategy in combatting resistance.
“We already have evidence that consuming probiotics reduces the incidence, duration, and severity of certain types of common acute respiratory and gastrointestinal infections,” Merenstein says. “The question is whether that reduction is solidly linked to declining use of antibiotics, and we see that there is an association.”
“More studies are needed in all ages, and particularly in the elderly, to see if sustained probiotic use is connected to an overall reduction in antibiotic prescriptions. If so, this could potentially have a huge impact on the use of probiotics in general medicine and consumers in general,” says the study's lead author Sarah King, PhD, from Cambridge, UK.
How probiotics help fight infections, especially those in the respiratory track and lower digestive tract, is not clear. However, Merenstein says, “There are many potential mechanisms, such as probiotic production of pathogen inhibitors, immune regulation, among others.
“We don't know all the mechanisms probiotic strains may leverage. But since most of the human immune system is found in the gastrointestinal tract, ingesting healthy bacteria may competitively exclude bacterial pathogens linked to gut infections and may prime the immune system to fight others,” he says.
The probiotics used in the reviewed studies were strains of Lactobacillus and Bifidobacterium.
Materials provided by Georgetown University Medical Center. Note: Content may be edited for style and length.
Probiotics: Possible side effects and how to take them safely
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Probiotics are healthful strains of live bacteria and yeast. Taking probiotics can provide a range of benefits, but it can also cause side effects.
In this article, we discuss what probiotics are, how they promote health, and how to take them safely.
Share on PinterestSauerkraut contains probiotics, which play an important role in digestion and gut health.
Trillions of bacteria and other microorganisms live in the gut. Scientists refer to this community of gut-dwelling organisms as the gut microbiota.
Research indicates that this microbiota plays an important role in digestion and gut health, while supporting the immune system, for example.
Some bacteria benefit their human hosts, while other types cause harm. Disturbing the natural balance of bacteria in the gut can lead to digestive problems, infections, and other issues.
Studies suggest that consuming probiotics can provide more healthful bacteria, which may help restore the balance of the gut microbiota.
Some yogurts, supplements, and fermented foods, including kefir, sauerkraut, and tempeh, contain probiotics.
The most common probiotics that manufacturers add to commercial products are species of Bifidobacterium and Lactobacillus bacteria.
A range of probiotic supplements and yogurts are available to purchase online.
Though taking probiotics may provide various benefits, it can also cause side effects, including:
When first using probiotics, some people experience gas, bloating, or diarrhea. Changes in the gut microbiota can result in bacteria producing more gas than usual, which can lead to bloating.
However, these side effects usually clear up within a few days or weeks of taking the probiotics. If the symptoms persist, speak with a doctor, who can explore the possible causes. In some cases, the doctor may recommend switching to a different probiotic.
In rare cases, probiotics may cause skin rashes or itchiness.
Authors of a 2018 review found that two study participants who took probiotics to treat IBS reported an itchy rash as a side effect. This led one participant to drop the trial.
If a rash or severe itching occurs, stop using the probiotic. Check the product’s labeling for any possible allergens, and see a doctor if the rash is severe, persistent, or it accompanies other concerning symptoms.
Once the rash has cleared, a person can try a different product or strain of probiotic.
Anyone with an allergy or intolerance for gluten, soy, eggs, dairy, or lactose may need to exercise caution when choosing probiotics.
As with any supplement, always check ingredients lists to ensure that there is no risk of an allergic reaction. Some manufacturers offer allergen-free probiotics.
Anyone experiencing symptoms of an allergic reaction should stop using the probiotic immediately. Seek medical care if the reaction is severe.
Increased risk of infection
Although probiotics are generally safe to use, findings of a review from 2017 suggest that children and adults with severe illnesses or compromised immune systems should avoid using probiotics. Some people with these conditions have experienced bacterial or fungal infections as a result of probiotic use.
If a person has a condition that affects their immune system, they should speak with their doctor before taking probiotics.
Also, anyone using antifungal medication should wait until the infection has cleared up before taking probiotics.
Small intestine bacterial overgrowth (SIBO)
The small and large intestines usually contain different types of bacteria. SIBO occurs when bacteria from the large intestine start growing in the small intestine.
The large intestine predominantly contains anaerobic bacteria, which do not require oxygen and live by fermenting indigestible carbohydrates from plant-based foods as they pass through the gut.
Symptoms of SIBO are similar to those of IBS, including gas, bloating, and diarrhea. SIBO can also cause brain fogginess and short-term memory problems.
Not everyone with IBS has SIBO, but the overgrowth is more common in people with IBS. SIBO also frequently develops in older females.
Experts do not fully understand what causes the overgrowth, but it may result from reduced gut motility, which slows the passage of food through the gut. This can cause fermentable carbohydrates to remain in the small intestine for longer.
Results of a 2018 study indicate a possible link between SIBO and probiotic supplementation in people with brain fogginess. The researchers found that symptoms improved when participants stopped taking probiotics and started taking antibiotics.
Anyone with SIBO symptoms should consult a doctor.
Rarely, probiotic bacteria can contain antibiotic-resistant genes. They can pass these genes on to other strains of bacteria, including the harmful strains that cause infections.
However, manufacturers systematically test commercial probiotics stains for the presence of antibiotic resistance. To reduce the risk of consuming antibiotic-resistant bacteria, always source probiotics from trusted, reputable manufacturers.
Little evidence suggests that a person can overdose on probiotics. However, always read labeling carefully and do not exceed the manufacturer’s recommended dosage.
The optimal dosage can vary, depending on a person’s health and the type of probiotic product.
If a probiotic causes any side effects or symptoms, consider reducing the dosage or refraining from taking the product.
Probiotics are beneficial strains of live bacteria or yeast. Regularly taking probiotics can help restore the natural balance of the gut microbiota. It may also help treat a number of health conditions, including IBS and IBD.
Probiotics are generally safe, and any side effects are usually mild and short-lived. However, if a symptom is causing concern, consider reducing the probiotic’s dosage, trying a different strain, or stopping use altogether.
Consult a doctor about any severe or persistent side effects.
Before using any probiotic product, read the instructions carefully and do not exceed the maximum dosage. People with allergies should also check labeling for potential triggers.
There is a selection of probiotics available for purchase online.
Are there alternatives to probiotic supplements?
Probiotics are found in many common foods, and a variety of types of healthy bacteria are available from the diet alone.
If you are considering taking probiotic supplements, research your manufacturer. The FDA do not monitor supplements, so it is wisest to buy from a reputable drugstore or health food chain. Always check expiry dates.
Check the colony forming units (CFU) on the bottle to see the amount of bacteria in the dose, and follow the manufacturer’s guidelines for how much to take. Some probiotic supplements require storage in a refrigerator.
Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
Take Probiotics to Fight Off Yeast and Bacteria Infections
Take Probiotics to Fight Off Yeast and Bacteria Infections
Probiotics are very beneficial for women. They are generally known for promoting gut health, but they can also help improve vaginal health. Women frequently encounter yeast infections in vaginal tissue and urinary tract bacterial infections.
According to one report, there are more than 300 million cases of urinary tract infetions, bacterial vaginosis, and yeast vaginitis worldwide every year1.
But, studies reveal that restoring healthy probiotic flora significantly helps protect against these types of infections.
by Harry Bronozian •
August 23, 2018
Yogurt has long been used as a remedy for infections of the vagina and now scientific studies confirm that yogurt probiotics as well as probiotic supplements can help reduce bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC)2.
The vagina is home to over 50 species of bacteria, just the digestive tract, which has over 400 different types of bacteria.
The underlying problem becomes a balance of good and bad bacteria because when there are no friendly bacteria the pathogens can cause a wide range of diseases and infections.
Luckily, bacterial strains from probiotics helps build up good bacteria for optimal health.
Also, the pH of vagina is normally kept at 4.2.
However, several factors – such as birth control pills, antiobiotics, use of tampons, spermicidal contraceptives, menopause, menstruation, pregnancy and sexual intercourse – can cause normal vaginal pH to rise or drop.
The rise of pH creates bacterial overgrowth and therefore causes BV. If the pH drops from overgrowth of fungus commonly known as Candida Albicans it causes yeast infections.
By taking probiotics, you can promote the health of vagina, digestive tract and urinary tract as well. The good bacteria from probiotics will ensure that harmful bacteria do not flourish.
Your body has naturally occurring “friendly” bacteria especially from that produce natural disinfectants which help maintain an optimal pH and healthy balance of microorganisms in the vagina by excluding harmful bacteria and other pathogens.
Numerous factors may upset the delicate balance of friendly microflora. These include antibiotic therapy, dietary changes, cigarette smoking, sexual activity, and high stress levels. Regardless of the cause, such factors may lead to overgrowth of pathogens causing yeast infections or bacterial vaginosis.
Fortunately, scientists have identifies specific species of bacteria that are effective at protecting vaginal and intestinal microflora and preventing overgrowth from unfriendly species of yeast and bacteria.
Clinical studies have shown that bacteria of the genus when consumed orally everyday are effective at establishing and maintain healthy vaginal microflora. A recent randomized, placebo-controlled, double-blind study found that women with high numbers of Lactobacilli in the vagina were far less ly to harbor yeast2.
Two species of in particular, (GR-1) and (RC-14), have been shown to be especially adept at colonizing the vaginal environment and fighting off attempts by unwelcome bacteria and fungi.
In 2001, research conducted at the University of Western Ontario demonstrated the ability of these specific strains of to “restore and maintain a normal urogenital flora” in women after just 28 days of daily oral use3.
There is strong evidence that the beneficial bacteria, GR-1 and RC-14, prevent against vaginal disorders. For optimal female health benefits, health care practitioners suggest supplementing with over 10 billion colony-forming units (cfu) of the strains each day.
- Reid G. Probiotic agents to protect the urogenital tract against infection. Am J Clin Nutr. 2001 Feb;73(2 Suppl):437S-43S.
- Ronnqvist PD, Forsgren-Brusk UB, Grahn-Hakansson EE. Lactobacilli in the female genital tract in relation to other genital microbes and vaginal pH. Acta Obstet Gynecol Scand. 2006;85(6):726-35.
- Reid G, Beuerman D, Heinemann C, Bruce AW. Probiotic Lactobacillus dose required to restore and maintain a normal vaginal flora. FEMS Immunol Med Microbiol. 2001 Dec;32(1):37-41.
Oral probiotics can resolve urogenital infections
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- Article contents
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- Supplementary Data
We report the first clinical evidence that probiotic lactobacilli can be delivered to the vagina following oral intake.
In 10 women with a history of recurrent yeast vaginitis, bacterial vaginosis (BV) and urinary tract infections, strains Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14 suspended in skim milk and given twice daily for 14 days, were recovered from the vagina and identified by morphology and molecular typing within 1 week of commencement of therapy.
In six cases of asymptomatic BV or intermediate BV (based upon Nugent scoring) was resolved within 1 week of therapy.
Probiotics, Urogenital, Bacterial vaginosis, Infection
Urogenital infections, including urinary tract infections (UTI), bacterial vaginosis (BV) and yeast vaginitis, afflict an estimated 1 000 000 000 people in the world annually. For patients suffering from BV, they have an increased risk of preterm labor and acquisition of sexually transmitted disease .
While antimicrobial agents are quite effective at providing clinical cure for bacterial infections, urogenital pathogen drug resistance is on the increase: those for Escherichia coli are as high as 18% in the US and Canada for trimethoprim/sulfamethoxazole [2,3] and 30% in Spain for fluoroquinolones .
These findings make it imperative that alternative strategies to disease management be developed.
One potential approach is the use of probiotics (essentially viable bacteria which confer a health benefit to the host).
A number of reliable  and unreliable  probiotic products are used extensively around the world, and indeed one Lactobacillus casei Shirota strain, present in Yakult drink (Yakult, Tokyo, Japan) is said to be taken by 24?000 000 people each day.
However, none of the reliable products have been designed for urogenital application, and their strain contents have no reported effectiveness against urogenital pathogens.
Studies in our laboratory, carried out over the past 20 years, have shown that specially selected probiotic Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum B-54 or RC-14, inserted into the vagina can colonize and compete against uropathogens and reduce the risk of UTI [7,8].
If these lactobacilli were able to be delivered to the vagina by oral ingestion, it would represent a major advance, for example in pregnant women with BV.
In addition, oral use could provide a practical way for women, many of whom are in developing countries, at high risk of sexually transmitted diseases to potentially better manage their urogenital health. Preliminary data in three volunteers showed that L. rhamnosus GR-1 and L.
fermentum RC-14 colonized the intestine, as proven by recovery in stool 1 week after therapy. Therefore, the present study was set up to determine whether oral intake of GR-1 and RC-14 could be used to deliver the organisms to the vagina by natural colonization and ascension.
2.1 Probiotic bacteria
Probiotic organisms, L. rhamnosus GR-1 and L.
fermentum RC-14, were selected on the basis of their production of various antagonistic factors against urogenital pathogens [5,9,10] including biosurfactants which inhibit adhesion of Gram-positive cocci including enterococci, staphylococci and Group B streptococci, and Gram-negative rods including coliforms and Gardnerella.
The organisms were grown in MRS broth in 5% CO2 at 37°C, harvested and washed in phosphate-buffered saline and resuspended in sterilized skim milk. A probiotic solution containing >109 viable L. rhamnosus GR-1 and L. fermentum RC-14 suspended in 3 ml sterilized skim milk (stored at -20°C) was then administered to patients.
2.2 Patients and methods of delivery and recovery of the lactobacilli
Each morning and last thing at night for 14 days, ten women, asymptomatic for infection but with a recent history of urogenital infection, swallowed 3 ml probiotic suspension.
The patients provided urine and vagina swabs pre-treatment and 1, 2, 3, and 4 weeks (and in 3 cases weeks 8 and 12) after commencement of the therapy. The swabs were suspended in 1 ml saline and cultured on MRS agar. Morphotypes of lactobacilli, particularly those suspected of being strains L.
rhamnosus GR-1 and L. fermentum RC-14 were further subcultured, Gram-stained and ribotyped. The ribotyping consisted of restriction of the genome with endonucleases, separation of the DNA by agarose gel electrophoresis and hybridization with rRNA (16S and 23S) from E.
coli as described in full previously . The fingerprints characteristic of L. rhamnosus GR-1 and L. fermentum RC-14 were identified. Controls consisted of a range of ATCC type strains of Lactobacillus, markers and samples without lactobacilli.
Each patient was asked to record any side effects such as bladder or vaginal irritation, discharge, or intestinal upset, and to inform us of any use of antimicrobial agents for infections occurring during the study.
The results showed that L. rhamnosus GR-1 and/or L. fermentum RC-14 were recovered from the vagina within one week in all 10 patients (Table 1). Patient AL did not provide samples after week 1 and patient SH received antibiotic therapy for bronchitis after week 3.
In three of the patients who provided vaginal samples at week 8 and 12, L. rhamnosus GR-1 and L. fermentum RC-14 were recovered. No side effects were noted. All patients reported improved well being with therapy.
This included relief of symptoms of urogenital infection, and reportedly no need for monthly yeast therapy. In the case of JA, the enterococci (present as 1000 per ml urine prior to therapy) were eradicated from her bladder and vagina (from 200 000 to 0 per ml) within 7 days.
At 16 months follow-up and continuing daily intake of L. rhamnosus GR-1 and L. fermentum RC-14, patient JA has remained infection-free. 1
Presence of lactobacilli and identification of L. rhamnosus GR-1 and L. fermentum RC-14
|TR||YV, UTI||low lacto||+||++||NS||++||++||++|
|SH||YV||no lacto||+||+++||++||++ Ant|
|GR-1 and RC-14 both recovered at each sampling time|
Nine of the 10 patients had a history of recurrent yeast vaginitis, two of recurrent BV, and three of recurrent UTI, but no such infections arose during treatment and follow-up.
Based upon the Nugent scoring system  which classifies the vaginal flora as BV, intermediate or normal, six patients (CK,TR,SH,BC,SB,JA) had an abnormal to BV flora which resolved with 1 week of probiotic treatment.
This study is significant for a number of reasons. Un antibiotic therapy used to prevent recurrence of UTI, there were no side effects and patients reported improved well-being and relief from their monthly cyclical recurrences of yeast vaginitis, BV or UTI.
Although no clinical efficacy can be claimed in the six cases where the vaginal flora indicated BV or intermediate at the beginning of the study and was restored to normal (dominated by lactobacilli) on therapy, the results make a good case for a larger, randomized, placebo-controlled trial.
The critical finding was the first conclusive proof that two probiotic lactobacilli, specifically selected for their ability to inhibit urogenital pathogen growth and adhesion, can colonize the vagina following oral intake. Notably, in each patient, one or both of the strains colonized the vagina, and remained several months thereafter.
This means that the organisms successfully survived the low pH and bile salt of the stomach, and passage through the intestine, and that they then ascended without functional intervention, into the vagina. This now makes it possible to use oral delivery to convey health benefits to the urogenital tract.
Both strains are acid and bile tolerant, but it is not clear what mechanisms they used to colonize the intestine and vagina. Probiotic therapy has been shown to be effective against diarrheal diseases [13,14], the world's second most common cause of death, and to confer a range of other health benefits . While L. rhamnosus GR-1 and L.
fermentum RC-14 have not been investigated fully to act in the intestine, their ability to colonize and inhibit the growth and adhesion of intestinal pathogens (unpublished data) could make them useful for this purpose, as well as for the urogenital tract.
As other intestinal strains lack some of the properties believed to be important for vaginal colonization [16,17], the use of GR-1 and RC-14 in combination could have clinical importance.
The ability of L. rhamnosus GR-1 and L. fermentum RC-14 to colonize the vagina confirms earlier data [7,8]. The finding that GR-1 colonized particularly well in some patients, and RC-14 in others stresses the importance of using more than one organism in probiotic products. Strain L.
fermentum RC-14 produces hydrogen peroxide, a property believed to be important in the healthy flora of the vagina , while L. rhamnosus GR-1 resists the killing action of spermicide nonoxynol-9.
Thus, the two strains provide combined advantages to colonize the vagina and potentially restore the urogenital flora in women with a history of BV, yeast vaginitis or UTIs.
Although only a limited set of strains have any proven clinical effect or scientific basis , there are sufficient data to suggest that this approach could provide a valuable alternative to antibiotic prophylaxis and treatment of infection.
By delivering properly selected lactobacilli strains orally, it is hereby shown that the healthy flora of the vagina can also be restored, thus potentially providing a practical means to reduce the risk of vaginal and bladder infections.
In developed as well as developing countries, such probiotic products could help relieve pain and complications associated with infection , and also provide a vehicle to deliver other nutritional benefits.
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International Symposium on Trends and Perspectives in the Management of Urinary Tract Infection, , . () Public health issues arising from microbiological and labelling quality of foods and supplements containing probiotic microorganisms. , –.
() Instillation of Lactobacillus and stimulation of indigenous organisms to prevent recurrence of urinary tract infections. , –. () Purification and characterization of a surface-binding protein from Lactobacillus fermentum RC-14 inhibiting Enterococcus faecalis 1131 adhesion. , –.
() Identification of collagen-binding proteins in Lactobacillus spp. with surface-enhanced laser desorption/ionization-time of flight ProteinChip technology. Appl. Environ. Microbiol., –. () Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial. J. Pediatr. Gastroenterol. Nutr.
, –. () In vitro analysis of a dairy strain of Lactobacillus acidophilus NCFM™ as a possible probiotic for the urogenital tract. , –. () Hydrogen peroxide-producing lactobacilli and acquisition of vaginal infections. , –.
Probiotics and Antibiotics Create a Killer Combination
In the fight against drug-resistant bacteria, MIT researchers have enlisted the help of beneficial bacteria known as probiotics.
In a new study, the researchers showed that by delivering a combination of antibiotic drugs and probiotics, they could eradicate two strains of drug-resistant bacteria that often infect wounds. To achieve this, they encapsulated the probiotic bacteria in a protective shell of alginate, a biocompatible material that prevents the probiotics from being killed by the antibiotic.
“There are so many bacteria now that are resistant to antibiotics, which is a serious problem for human health. We think one way to treat them is by encapsulating a live probiotic and letting it do its job,” says Ana Jaklenec, a research scientist at MIT's Koch Institute for Integrative Cancer Research and one of the senior authors of the study.
If shown to be successful in future tests in animals and humans, the probiotic/antibiotic combination could be incorporated into dressings for wounds, where it could help heal infected chronic wounds, the researchers say.
Robert Langer, the David H. Koch Institute Professor and a member of the Koch Institute, is also a senior author of the paper, which appears in the journal Advanced Materials on Oct. 17. Zhihao Li, a former MIT visiting scientist, is the study's lead author.
The human body contains trillions of bacterial cells, many of which are beneficial. In some cases, these bacteria help fend off infection by secreting antimicrobial peptides and other compounds that kill pathogenic strains of bacteria. Others outcompete harmful strains by taking up nutrients and other critical resources.
Scientists have previously tested the idea of applying probiotics to chronic wounds, and they've had some success in studies of patients with burns, Li says.
However, the probiotic strains usually can't combat all of the bacteria that would be found in an infected wound.
Combining these strains with traditional antibiotics would help to kill more of the pathogenic bacteria, but the antibiotic would ly also kill off the probiotic bacteria.
The MIT team devised a way to get around this problem by encapsulating the probiotic bacteria so that they would not be affected by the antibiotic.
They chose alginate in part because it is already used in dressings for chronic wounds, where it helps to absorb secretions and keep the wound dry.
Additionally, the researchers also found that alginate is a component of the biofilms that clusters of bacteria form to protect themselves from antibiotics.
“We looked into the molecular components of biofilms and we found that for Pseudomonas infection, alginate is very important for its resistance against antibiotics,” Li says. “However, so far no one has used this ability to protect good bacteria from antibiotics.”
For this study, the researchers chose to encapsulate a type of commercially available probiotic known as Bio-K+, which consists of three strains of Lactobacillus bacteria. These strains are known to kill methicillin-resistant Staphylococcus aureus (MRSA).
The exact mechanism by which they do this is not known, but one possibility is that the pathogens are susceptible to lactic acid produced by the probiotics.
Another possibility is that the probiotics secrete antimicrobial peptides or other proteins that kill the pathogens or disrupt their ability to form biofilms.
The researchers delivered the encapsulated probiotics along with an antibiotic called tobramycin, which they chose among other tested antibiotics because it effectively kills Pseudomonas aeruginosa, another strain commonly found in wound infections. When MRSA and Pseudomonas aeruginosa growing in a lab dish were exposed to the combination of encapsulated Bio-K+ and tobramycin, all of the pathogenic bacteria were wiped out.
“It was quite a drastic effect,” Jaklenec says. “It completely eradicated the bacteria.”
When they tried the same experiment with nonencapsulated probiotics, the probiotics were killed by the antibiotics, allowing the MRSA bacteria to survive.
“When we just used one component, either antibiotics or probiotics, they couldn't eradicate all the pathogens. That's something which can be very important in clinical settings where you have wounds with different bacteria, and antibiotics are not enough to kill all the bacteria,” Li says.
The researchers envision that this approach could be used to develop new types of bandages or other wound dressings embedded with antibiotics and alginate-encapsulated probiotics. Before that can happen, they plan to further test the approach in animals and possibly in humans.
“The good thing about alginate is it's FDA-approved, and the probiotic we use is approved as well,” Li says. “I think probiotics can be something that may revolutionize wound treatment in the future. With our work, we have expanded the application possibilities of probiotics.”
In a study published in 2016, the researchers demonstrated that coating probiotics with layers of alginate and another polysaccharide called chitosan could protect them from being broken down in the gastrointestinal tract.
This could help researchers develop ways to treat disease or improve digestion with orally delivered probiotics.
Another potential application is using these probiotics to replenish the gut microbiome after treatment with antibiotics, which can wipe out beneficial bacteria at the same time that they clear up an infection.
Li's work on this project was funded by the Swiss Janggen-Poehn Foundation and by Beatrice Beck-Schimmer and Hans-Ruedi Gonzenbach.