Probiotics: Preventing Complications of Antibiotic Use
What are probiotics? Clinical Evidence of Efficacy

Reducing the risk of AAD and CDAD can improve the tolerability of antibiotics and adherence to treatment, which increases the likelihood of treatment success.

Probiotics are thought to reduce the risk of CDAD through multiple mechanism of action including:17

  • Alteration of intestinal microbiota
  • Antimicrobial activity
  • Intestinal barrier protection
  • Modulation of the immune system

A limited number of probiotics have been proven effective in clinical studies and have approved labelling claims for the prevention or management of AAD (see Table).

In Canada, only one particular probiotic combination, Bio-K+, has been given a health claim against C. difficile. Bio-K+ is a combination of Lactobacillus acidophilus CL1285, Lactobacillus casei LBC80R and Lactobacillus rhamnosus CLR2.

Table: Probiotics with approved labelling claims for the prevention of CDAD and AAD

ProductIncluded StrainsStrength and Recommended DosePharmaceutical Formulation Approved Health Claims1
Bio-K+L. acidophilus CL1285, L. casei LBC80R and L. rhamnosus CLR2 50 billion live and active L. acidophilus CL1285, L. casei LBC80R and L. rhamnosus CLR2 at the expiration date

2 capsules after the first dose of the prescribed antibiotic therapy and continue daily, plus for 5 additional days after completion of the antibiotic therapy.

Should be administered at least 2 hours after consuming the antibiotic dose
Fermented milk and freeze-dried bacteria placed in an enteric coated capsule

Labelled stability:

140 days for fermented milk and 2 years for capsules if kept refrigerated
Helps to reduce the risk of Clostridium difficile associated diarrhea (CDAD) in hospitalized patients.

Helps to reduce the risk of Antibiotic-associated Diarrhea (AAD).

Probiotic that forms part of a natural healthy gut flora.

Provides live microorganisms that form part of a natural healthy gut flora.

Probiotic that contributes to a natural healthy gut flora.

Probiotic to benefit health and/or confer a health benefit.

Provides live microorganisms to benefit health and/or to confer a health benefit.
CulturelleL. rhamnosus GG ATCC53103 10 billion CFU

One capsule daily
Encapsulated

Store in a cool dry place away from direct sunlight and at room temperature or below.
Helps to manage acute infectious diarrhea.

Helps to manage antibiotic-associated diarrhea.

Helps to reduce the risk of antibiotic-associated diarrhea.

Probiotic that forms part of natural healthy gut flora.

Provides live microorganisms that form part of a natural healthy gut flora.

Probiotic that contributes to a natural healthy gut flora.

Provides live microorganism that contribute to a natural healthy gut flora.

Helps support intestinal health.

Helps support gastrointestinal health.
Florastor Saccharomyces boulardii lyo 5 billion CFU per 250 mg capsule

Two capsules twice daily
Lyophilized

Store at room temperature
Helps prevent antibiotic-associated diarrhea.

Helps reduce the symptoms related to acute diarrhea (infectious).
Proxiflor (formerly Lacidofil)L. rhamnosus (L. Rosell‐11)

L. helveticus (L. Rosell‐52)
3.8 billion CFU

0.2 billion CFU

1 to 2 capsules taken 1 to 3 times daily.
Encapsulated Probiotic to benefit health and/or confer a health benefit.

Restoring and maintaining intestinal flora.

Helps to reduce the risk of antibiotic-associated diarrhea (in children and adolescents from 2 to 18 years of age).
CFU = colony forming unit
1 Health Canada’s Licensed Natural Health Products Database