The imbalance of the bacterial composition in the gut microbiome is called dysbiosis. One form of this can be low-diversity dysbiosis, which is often caused by broad-spectrum antibiotic therapy [ 1]. Decreased gut microbiome diversity has been associated with obesity, inflammatory bowel disease, liver disease, and recurrent Clostridioides difficile infection, among other pathologies. Maintaining the gut microbial diversity during periods of potential impairment seems important [ 3, 65]. Probiotics are widely used to prevent this dysbiotic state during antibiotic therapy; however, their role and effect on the gut microbiome are still in question.

Changes in the level of Enterobacteriaceae family were inconsistent across the studies. Several articles reported an increasing trend of Enterobacteriaceae in the probiotic supplemented group only [ 55, 62]; however, according to other studies [ 57, 58], this increase was observed only in the control group. Meanwhile, Forssten et al. and MacPherson et al. reported a higher relative abundance of Enterobacteriaceae in both groups after antibiotic treatment, which normalized after 2 weeks of follow-up [ 51, 63]. Changes in the other bacterial families were heterogeneously reported (see Tables S 3 and S 4).Kabbani TA, Pallav K, Dowd SE, Villafuerte-Galvez J, Vanga RR, Castillo NE, et al. Prospective randomized controlled study on the effects of Saccharomyces boulardii CNCM I-745 and amoxicillin-clavulanate or the combination on the gut microbiota of healthy volunteers. Gut Microbes. 2017;8:17–32. The summary of the available literature facilitates the utilization of scientific results in daily practice, which is crucially important [ 78, 79]. According to our findings, probiotics have only a minimal and temporary effect on the composition and diversity of gut microbiome during antibiotic therapy and are not suitable for preventing antibiotic-induced low-diversity dysbiosis. In this regard, strain-specific probiotic supplementation with antibiotics may be considered especially for vulnerable groups to prevent Clostridioides difficile infection or antibiotic-associated diarrhea, as advised by the current guideline of the AGA and WGO on the use of probiotics [ 11, 12]. These findings were however not connected to gut microbial compositions. Given our results, which describe a low moderating effect on gut flora, the question arises as to what exactly is the mechanism by which probiotics help prevent these conditions. A recent meta-analysis also points out that some strains may be more effective in the prevention of diarrhea and that the effect depends on the initial risk level. According to this, patients with a low baseline diarrhea risk do not benefit from probiotic supplementation during antibiotic treatment [ 80]. Our findings do not suggest any further benefit regarding microbiome composition. Further evaluation of the relation between clinical manifestations, microbial diversity indices, and taxonomic composition will bring a more comprehensive understanding of the role of gut microbes in human health and how different factors affect it. The standardization of methods for microbiome diversity measurement and the definition of its optimal value are key factors in generating more homogenous data with increased clinical relevance. A measurement after a standard follow-up period should be considered for all future similar studies to determine the long-term effects. Herboxa Probiotic je vysoce potentní doplněk stravy s unikátním složením, který pomáhá tělu opětovně získat střevní flóru Oh B, Kim BS, Kim JW, Kim JS, Koh SJ, Kim BG, et al. The effect of probiotics on gut microbiota during the Helicobacter pylori eradication: Randomized Controlled Trial. Helicobacter. 2016;21:165–74. Mezzasalma, V., et al. (2016). A randomized, double-blind, placebo-controlled trial: The efficacy of multispecies probiotic supplementation in alleviating symptoms of irritable bowel syndrome associated with constipation.

Ribeiro CFA, Silveira GGDOS, Cândido EDS, Cardoso MH, Espínola Carvalho CM, Franco OL. Effects of antibiotic treatment on gut microbiota and how to overcome its negative impacts on human health. ACS Infect Dis. 2020;6:2544–59. We performed a systematic review and meta-analysis of randomized controlled trials reporting the differences in gut microbiome diversity between patients on antibiotic therapy with and without concomitant probiotic supplementation. The systematic search was performed in three databases (MEDLINE (via PubMed), Embase, and Cochrane Central Register of Controlled Trials (CENTRAL)) without filters on 15 October 2021. A random-effects model was used to estimate pooled mean differences (MD) with 95% confidence intervals (CI). This review was registered on PROSPERO (CRD42021282983). Results Cárdenas PA, Garcés D, Prado-Vivar B, Flores N, Fornasini M, Cohen H, et al. Effect of Saccharomyces boulardii CNCM I-745 as complementary treatment of Helicobacter pylori infection on gut microbiome. Eur J Clin Microbiol Infect Dis. 2020;39:1365–72. Lozupone CA, Stombaugh JI, Gordon JI, Jansson JK, Knight R. Diversity, stability and resilience of the human gut microbiota. Nature. 2012;489:220–30. Pielou EC. The measurement of diversity in different types of biological collections. J Theor Biol. 1966;13 C:131–44.The summarized results of the taxonomic analysis of microbiome composition, as measured immediately at the end of simultaneous antibiotic and probiotic treatment, are presented in Additional File 2: Table S3. The results of the follow-up measurements (after cessation of antibiotic and probiotic treatments) are summarized in Additional File 2: Table S4. Risk of bias assessment Strong WL. Assessing species abundance unevenness within and between plant communities. Community Ecol. 2002;3:237–46. PRO biotika jsou živé mikroorganismy s výhodnými účinky vůči zdraví. Často se označují za "přítelské" nebo "dobré" bakterie, které podporují imunitní systém, střeva a celkové zdraví. Existují přirozeně v trávícím traktu a pomáhají chránit proti škodlivým bakteriím a plísním. Hanchi H, Mottawea W, Sebei K, Hammami R. The genus Enterococcus: between probiotic potential and safety concerns-an update. Front Microbiol. 2018;9:1–16. Probiotics could be a helpful addition to treatment for some individuals with IBS. However, it is unclear how probiotics can treat this condition.

Schubert AM, Rogers MAM, Ring C, Mogle J, Petrosino JP, Young VB, et al. Microbiome data distinguish patients with clostridium difficile infection and non-c Difficile-associated diarrhea from healthy controls. MBio. 2014;5:1–9. Chao A. Nonparametric estimation of the number of classes in a population. Scand J Stat. 1984;11:265–70. The additional sensitivity analysis for the baseline and the change values revealed no significant difference between groups either (Additional File 3: Fig. S5-6) (change: MD = 8.09 [(−)3.87–20.05]). Qualitative synthesis The impact of simultaneous probiotic supplementation during antibiotic treatment on α-diversity indices Gilbert JA, Lynch SV. Community ecology as a framework for human microbiome research. Nat Med. 2019;25:884–9.Dale, H. F., et al. (2019). Probiotics in irritable bowel syndrome: An up-to-date systematic review. The main strength of the study is the high level of evidence for our quantitative results as we included only randomized controlled trials in our review and meta-analysis. Moreover, to our knowledge, this is the first meta-analysis and the most comprehensive review of the topic to date. We followed the strict guidelines of Cochrane recommendations [ 18] and PRISMA Statement [ 19] when performing our systematic review and meta-analysis, which is strengthening our results. Our results showed that probiotic supplementation during antibiotic therapy was not found to be influential on gut microbiome diversity indices. Defining appropriate microbiome diversity indices, their standard ranges, and their clinical relevance would be crucial. Excess gas can be caused by an imbalance of lactic acid in your gut. Our probiotic formula contains Bifidobacterium and Lactobacillus strains that can produce lactic acid and help reduce odorous gas. Gives your gut the support it needs Our probiotic contains 60 billion live and active microbes in each serving at the time of manufacturing. This high-potency formula allows a greater chance of healthy microbes colonizing in your gut. We ensure maximum concentration and effectiveness with zero unnecessary binders, GMOs, gluten, colors, preservatives, or other additives. Synergistic support

Probiotics are often used to prevent antibiotic-induced low-diversity dysbiosis, however their effect is not yet sufficiently summarized in this regard. We aimed to investigate the effects of concurrent probiotic supplementation on gut microbiome composition during antibiotic therapy. Methods Antibiotic treatment affects the gut bacterial microbiota quantitatively and qualitatively, causing a decrease or even extinction of certain species, leading to a low-diversity microbiome, and allowing some potentially harmful bacteria to become dominant, e.g., Clostridium perfringens, Staphylococcus aureus, or Clostridioides difficile [ 1, 2]. This microbial imbalance is called dysbiosis. The deviation from the normal microbiome has been linked to obesity, malnutrition, inflammatory bowel disease, neurological dysfunctions, and cancer [ 3]. The gut microbiota can spontaneously recover, but it is influenced by various host and external factors like age, health status, the geographical area of origin of patients, dose, duration, and the spectrum of antibiotic treatment [ 4, 5, 6]. Young, healthy adults have stable microbial community functions [ 7], but repeated perturbation of the ecosystem is particularly detrimental if there is insufficient time for recovery after the initial impairment. Previous research has shown that the gut microbiota recovers within about 2 weeks after a single antibiotic exposure in adults, but repeated exposures can significantly prolong the recovery time [ 4, 8, 9, 10].

Plummer SF, Garaiova I, Sarvotham T, Cottrell SL, Le Scouiller S, Weaver MA, et al. Effects of probiotics on the composition of the intestinal microbiota following antibiotic therapy. Int J Antimicrob Agents. 2005;26:69–74. As there was a large difference in the baseline values between the intervention and control groups in the article of Kakiuchi et al. [ 50] (MD = 21.57 [3.47–39.68]), here, we also performed an additional sensitivity analysis for the baseline values and the changes (Additional File 3: Fig. S3-4) with no significant difference in the latter between the groups (MD = 3.77 [(−)10.17–17.71]). The impact of probiotic supplementation during antibiotic therapy on observed OTUs Gotelli NJ, Colwell RK. Estimating species richness. In: Diversity Biological, editor. Frontiers in Measurement and Assessment. Oxford University Press: United Kingdom; 2011. p. 39–54. Qian XB, Chen T, Xu YP, Chen L, Sun FX, Lu MP, et al. A guide to human microbiome research: Study design, sample collection, and bioinformatics analysis. Chin Med J (Engl). 2020;133:1844–55.