Health officials have asked doctors to stop overprescribing antibiotics. Probiotics have an opportunity to gain ground.
by Peilin Guo
Tens of millions of antibiotic doses are prescribed for diseases they can’t cure. As a result, a major health problem is imminent unless doctors stop overprescribing antibiotics. The alarm was raised in September by officials at the U.S. Department of Health and Human Services (Washington, DC). The problem, according to the Centers for Disease Control and Prevention (CDC; Atlanta), is that almost every species of bacteria has become resistant to antibiotics.
Even powerful antibiotics have become less effective. The rate of penicillin resistance increased by more than 300% over the last 5 years, while the rate of cefotaxime resistance increased by more than 1000%. The problem advanced far enough for CDC to tell doctors that vancomycin is the only remaining antibiotic effective against pneumococci, and that bacteria have developed resistance to cephalosporins, erythromycin, trimethoprim- sulfamethoxazole, and quinolones.
Doctors have been overprescribing antibiotics in response to time pressures, demanding patients, and inexact diagnoses, according to CDC. Overprescribing is particularly prevalent with kids. According to CDC, a national office-based study suggested that antibiotic use among children increased by 48%.
In September, health officials launched a national education campaign to stop overprescription at its roots. Television, radio, and print ads will soon inform consumers that antibiotics are meant for strep throat, sinus infections, and bacterial pneumonia, not bronchitis, sore throats, flu symptoms, or the majority of children’s ear infections.
Doctors, too, will be reminded that prescription antibiotics aren’t a cure-all. Data sheets will be available for pushy patients, and an owl toy wearing a T-shirt with the slogan “Get Smart: Know When Antibiotics Work,” will remind doctors not to give in to anxious parents.
The CDC’s campaign presents an opportunity for immune-support products, particularly probiotics. Most consumers know that yogurt contains probiotic bacteria. They also know that it’s important to support the health of the beneficial bacteria in their bodies.
Probiotic microflora help reduce infections and maintain intestinal microflora balance. Probiotics directly inhibit the pathogenic bacteria in the intestine by competing for nutrients and residential space. They create an unfriendly, low-pH environment for pathogenic and putrefactive bacteria by producing organic acids, such as lactic acid, acetic acid, and propionic acid. And, they produce natural antibiotics, such as acidolin, acidophilin, bulgaricin, and plantaricin (bacteriocines), and other substances that inhibit the growth of pathogens.
Intestinal microflora also may significantly influence immune response. Probiotic bacteria modulate host defense mechanisms by affecting both nonspecific and gut-associated immune functions.
Oral administration of various lactic acid–producing bacteria, such as L. acidophilus and L. casei, affects the production of IgA-producing cells, enhancing levels of interferon-alpha and polymorphonuclear cell phagocytic capacity. Probiotic bacteria can also suppress inflammatory response and help control intestinal inflammatory diseases. Furthermore, studies show that there is a correlative or suggestive link between immune modulation and enhanced protection by probiotic bacteria.
Probiotic bacteria also reduce primary infections in both experimental and clinical settings. Researchers who conducted a double-blind, randomized trial with children attending day care observed that children who consumed milk fermented with Lactobacillus rhamnosus GG daily had significantly fewer days of absence from day care due to illness. The number of children suffering from respiratory infections with complications also was less. Additionally, there were fewer antibiotic treatments for respiratory infection among those who took a product containing probiotics compared with those in the control group.
The Centers for Disease Control and Prevention (CDC; Atlanta), FDA (Rockville, MD), and a consortium of national health organizations have announced a national campaign to teach consumers to be cautious about their use of antibiotics during the cold and flu season.
“Antibiotics are powerful drugs. In fact, sometimes we imagine they are wonder drugs that can treat any infection,” says CDC director Julie Gerberding, MD. “But the truth is antibiotics only work against bacteria, not the viruses that cause colds and flu.”
“Get Smart: Know When Antibiotics Work” is CDC’s first consumer campaign. Television, radio, and print ads will convey a simple message to consumers – antibiotics are useless against viruses like colds and flu.
“Our first step toward correcting the problem is to build public knowledge and awareness of when antibiotics work and when they don’t,” said Richard Besser, MD, CDC’s medical director of the campaign. “We want Americans to keep their families and communities healthy by getting smart about the proper use of antibiotics.”
The campaign will also target doctors. Tools include disease-specific fact sheets, prescription pads with alternative treatments for cold and flu symptoms, and an owl toy hung on pediatricians’ stethoscopes. The owl wears a T-shirt with the slogan “Get Smart: Know When Antibiotics Work.”
Probiotics, especially those belonging to Lactobacillus and Bifidobacterium genera, have a very good track record in terms of safety. There have been no reported drug-probiotic interactions. However, not all species have the same influence on the host, and people with different physiological conditions will have various responses to organisms. There have been some isolated incidences in which beneficial bacteria have become infectious.
Probiotics should not be recommended to people with compromised immune systems or with conditions prone to infections. People with these conditions should consult their physician before taking probiotic supplements or fermented foods.
Selecting Probiotic Supplements
The viability of probiotic organisms is very sensitive to temperature and moisture. They are usually unstable when nonrefrigerated or exposed to moisture. Unless a product is specially manufactured with a systematic control procedure, such as strain selection, fermentation medium, environment, drying, encapsulation, and coating, it should be refrigerated. Consumers should question products claiming “no refrigeration needed,” and ask for the documentation from the manufacturer.
Another issue is whether to take a probiotic product with a single strain or mixed strains. Since numerous microorganisms cohabitate in the human intestine, and each probiotic strain is unique, there is a trend toward recommending supplementation with mixed strains.
The suggested dose of live bacteria is 3 billion to 4 billion units (sometimes referred to as colony forming units, or CFUs) daily, but the dose may vary depending on a person’s physiological condition.
Probiotic supplements can be found in health/natural food stores and selected supermarkets and drug stores. Probiotics are also available in fermented foods, such as yogurt (especially yogurt with three bacterial strains), acidophilus milk, capsules, tablets, powder, and liquid.
There are hundreds of different bacterial species inhabiting the human gut, most being anaerobic. Although the intestines of a fetus are free from bacteria, the colonization of newborns’ intestines starts immediately with delivery through the birth canal.
The composition of intestinal microflora varies from one person to another depending on a person’s diet, age, medication, stress levels, and physiological conditions. While Bifidobacterium infantis and B. breve are often the predominant friendly bacteria in infants, the proportion of bifidobacteria in breast-fed infants is higher than that of bottle-fed babies. Breast-fed infants, for example, have more Bifidobacterium and fewer Enterococci than formula-fed babies.
Among the hundreds of bacterial species in the human digestive tract, some are potentially pathogenic or putrefactive, while others (probiotics) are friendly. Probiotic foods and supplements tend to use lactic acid, gram-positive, nonsporing, anaerobic bacteria.
With probiotic supplements, the name of the game is getting enough bacteria through the digestive system. “Different strains of probiotic bacteria have different sensitivities to gastric acid and bile salts,” says Rakesh Kapoor, PhD, director of science and technology at Bioriginal Food & Science (Saskatoon, SK, Canada). “The strains with lower survivability must be consumed in high doses. Selection of probiotic bacteria with high resistance to gastric acid and bile assures the benefits of supplements. We pay close attention to these parameters in strain selection for formulations.”
The formula is as important as the strain. “The proper formulation protects bacteria during shelf life,” says Kapoor. “For consumers, it is important to consume a certain level of probiotic bacteria.”
Source: Nutritional Outlook Nov/Dec 2003, online at http://www.nutritionaloutlook.com. © Nutritional Outlook.