With careful consideration and appropriate use as a complementary therapy, probiotics may be a valuable tool in the fight against antibiotic resistance.

Antibiotic resistance is a growing public health concern, with many strains of bacteria becoming increasingly difficult to treat with traditional antibiotics. As a result, there is a need for alternative treatments that can help to combat antibiotic-resistant infections. One potential option is the use of probiotics as a complementary therapy.

Probiotics are live microorganisms that confer health benefits when ingested. Most known for their ability to support gut health, research suggests they may also have the potential to enhance the effectiveness of antibiotics, particularly in cases of antibiotic-resistant infections.

COMPETITIVE EXCLUSION^1,2,3,4

One mechanism by which probiotics may combat antibiotic-resistant bacteria is through competitive exclusion. Probiotic bacteria can help to colonise the gut and outcompete harmful bacteria, preventing them from proliferating and causing infection. This can reduce the overall burden of antibiotic-resistant bacteria in the gut, potentially making it easier for antibiotics to be effective when they are needed.

PRODUCTION OF ANTIMICROBIAL COMPOUNDS^5,6

Some strains of probiotic bacteria can produce antimicrobial compounds, such as bacteriocins, that can kill or inhibit the growth of harmful bacteria. These compounds may be effective against antibiotic-resistant strains, which are often more difficult to treat with traditional antibiotics. For example, some strains of Lactobacillus have been shown to produce bacteriocins that are active against antibiotic-resistant strains of E. coli and Staphylococcus aureus.

MODULATION OF THE IMMUNE SYSTEM^7,8,9,10

Probiotic bacteria can also help to regulate the immune system, potentially enhancing the body's ability to fight off infections. This may be particularly important in cases of antibiotic-resistant infections, where the immune system may be compromised or overwhelmed. For example, some strains of Bifidobacterium have been shown to enhance the activity of immune cells in the gut, potentially reducing the risk of infection.

RESTORATION OF THE GUT MICROBIOME^11,12

Antibiotic treatment can disrupt the balance of bacteria in the gut, leading to overgrowth of harmful bacteria and increased risk of infection. Probiotics may help to restore this balance, promoting the growth of beneficial bacteria and reducing the risk of infection. This may be particularly important in cases where antibiotic treatment has caused significant disruption to the gut microbiome, such as in cases of recurrent Clostridioides difficile infection.

CHOOSING THE RIGHT PROBIOTIC

If patients are interested in using probiotics as a complementary therapy for antibiotic-resistant infections, it is important to choose the right probiotic supplement. Different strains of bacteria may have different effects on the body, and not all strains may be effective against antibiotic-resistant strains of bacteria.

CONCLUSION

Overall, while more research is needed to fully understand the potential of probiotics as a complementary therapy in the fight against antibiotic resistance, there is growing interest in this approach. “In some cases, probiotics will be the difference between a good quality of life and a bad one, or perhaps even life over death,” wrote Dr Gregor Reid in the Canadian Journal of Infectious Diseases and Medical Microbiology. “If supported, research into indigenous and probiotic microbes will form an important part of future research that sheds light on health, disease and a basic understanding of life itself.”¹³

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