The prescription of antibiotics is common when the hypothesis of infection by a microorganism is raised. Two out of three times, it is linked to ENT and respiratory diseases, but lower urinary tract or skin conditions are also particularly concerned.
Sometimes, however, these drugs are misused, when the pathology is due to a virus for example. This is the case for ear infections of viral origin, when they are confused with those of bacterial origin. This overconsumption, beyond antibiotic resistance issuesthat it causes, is not without consequences on health. In particular on the intestinal microbiota.
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Gut microbiota disruption
In the human body, there are “organs” within the organs. These are clean ecosystems, called microbiota, which host a large number of microorganisms. the intestinal microbiota, also called intestinal flora, is one of the most important. By itself, it represents 1 kg of our body weight and hosts 100,000 billion bacteria, fungi, yeasts … Each person has their own ecosystem, their own specific “fingerprint”. Because of the 1000 species identified in the intestinal microbiota of humans, only about twenty are common to the entire population.
Disturbance of balance
This balance of “good” and “bad” bacteria present in the stomach is disturbed by antibiotics. The phenomenon is called dysbiosis. The diversity of microorganisms is altered. The intestine “leaks” and is more permeable to pathogens, which causes inflammation. Links have thus been established between the consumption of antibiotics by young children and certain diseases (obesity, chronic inflammatory bowel disease, asthma, diabetes, etc.).
One of the unwanted symptoms the most common antibiotic is diarrhea. Between 3.2 and 37% of people taking these drugs would experience post-antibiotic diarrhea (AAD). Some antibiotics are more at risk than others. For example, the combination of amoxicillin and clavulanic acid would be critical for these manifestations – in addition to generating bacterial resistance. Children 0-14 years old, women or the elderly are most vulnerable to these intestinal problems.
The probiotic solution
The microbiota, decimated by antibiotics, can be restored using several methods. Dr Marc Bellaiche, gastro-pediatrician at the Robert Debré Hospital (Paris), compares the situation to a lawn scorched by the sun. There are three solutions. Either the entire lawn is replaced, which can be compared to a fecal transplant. Either we replant everything, it is then a question of the use of prebiotics. Either we plant new seeds, with probiotics.
Probiotics have several roles. By colonizing the digestive tract, they protect against pathogens, modulate the immune system and metabolic functions, play a role in the intestine-brain axis … To be effective, they must be resistant to digestive juices, but especially antibiotics. Thus, all strains and associations are not created equal.
Good associations
In particular, researchers have demonstrated the protective effects of Saccharomyces boulardii with the Lactobacillus rhamnosus GG. “Combined, these strains would prevent diarrhea in 1 in 9”, explains the gastro-pediatrician. Data confirmed by a report of the Cochrane Library, published on April 30. In the studies recently carried out, the use of these probiotics would indeed have made it possible to reduce the expansion of “bad” bacteria, and to restore the metabolic activity as well as the diversity of the composition of the intestinal microbiota.
In order to prevent post-antibiotic diarrhea, Béatrice Clairaz-Mahiou, Doctor of Pharmacy in Chatenay-Malabry, also advises more support for patients:
- By inviting them to respect the dosages;
- By alerting them to unwanted effects;
- By adapting prescriptions to their needs and lifestyles;
- By giving them advice on probiotics.
“Antibiotics are not automatic. But choosing a good probiotic is systematic”, adds Dr Bellaiche.
Interview during the presentation of Smebiocta protect by the Ipsen laboratory, June 18, 2019.
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