One of the side effects of antimicrobial therapy is a disturbance of the intestinal microbiota potentially resulting in antibiotic-associated diarrhea (AAD). In this placebo-controlled double-blind study, the effect of a multispecies probiotic on the composition and metabolic activity of the intestinal microbiota and bowel habits was studied in healthy volunteers taking amoxycillin.
Forty-one healthy volunteers were given 500 mg amoxycillin twice daily for 7 days and were randomized to either 5 g of a multispecies probiotic, Ecologic® AAD (109 cfu/g), or placebo, twice daily for 14 days. Feces and questionnaires were collected on day 0, 7, 14, and 63. Feces was analyzed as to the composition of the intestinal microbiota, and β-glucosidase activity, endotoxin concentration, Clostridium difficile toxin A, short chain fatty acids (SCFAs), and pH were determined. Bowel movements were scored according to the Bristol stool form scale.
Mean number of enterococci increased significantly from log 4.1 at day 0 to log 5.8 (day 7) and log 6.9 (day 14) cfu/g feces (P < 0.05) during probiotic intake. Although no other significant differences were observed between both intervention groups, within each group significant changes were found over time in both microbial composition and metabolic activity. Moreover, bowel movements with a frequency ≥3 per day for at least 2 days and/or a consistency ≥5 for at least 2 days were reported less frequently in the probiotic compared to the placebo group (48%vs 79%, P < 0.05).
Apart from an increase in enterococci no significant differences in microbial composition and metabolic activity were observed in the probiotic compared with the placebo group. However, changes over time were present in both groups, which differed significantly between the probiotic and the placebo arm, suggesting that the amoxycillin effect was modulated by probiotic intake. Moreover, the intake of a multispecies probiotic significantly reduced diarrhea-like bowel movements in healthy volunteers receiving amoxycillin.
1Division of Gastroenterology-Hepatology; 2Department of Medical Microbiology, University Hospital Maastricht, Maastricht, The Netherlands; 3Winclove Bio Industries B.V., Amsterdam, The Netherlands; and 4Laboratory of Food Microbiology, Department of Agrotechnology and Food Sciences, Wageningen University, Wageningen, The Netherlands
Reprint requests and correspondence: C.J.M. Koning, Division of Gastroenterology-Hepatology, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
Received December 15, 2006; accepted August 5, 2007.
CONFLICT OF INTERESTGuarantor of the article: R.W. Stockbrügger, M.D., Ph.D.
Specific author contributions: Catherina J.M. Koning was the principal investigator. Catherina J.M. Koning and Daisy M.A.E. Jonkers were responsible for the analyses of the study. All authors participated in the design and data interpretation of the study and contributed significantly to the various drafts of the manuscript.
Financial support: This study was sponsored by SenterNovem, an agency of the Dutch Ministry of Economic Affairs (grant no. TSGE 1041).
Potential competing interests: Linda Mulder and Frans M. Rombouts are employees of Winclove Bio industries B.V. Catherina J.M. Koning is supported, in part, by a grant from SenterNovem and, in part, by Winclove Bio Industries B.V.