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November, 18

European Antibiotic Day


The European Antibiotic Awareness Day is an annual European public health initiative that takes place on November, 18 to raise awareness about the threat to public health of antibiotic resistance and the importance of prudent antibiotic use. Given the harmful impact antibiotics have on the gut microbiota, awareness should also be raised of the importance to reduce these disturbances.

Use this day to communicate the significance of probiotic use during antibiotic use to your healthcare professionals!

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Key messages:  


Timely use of probiotics during an antibiotic course can:


Directly improve patients' quality of life

In the short term, probiotics reduce the risk of the life threatening Clossitridum diffile associated diarhoea and antibiotic associated diarhoea.  


 Prevent chronic diseases

In the long term, probiotics protect the microbiota from permament disturbances and reduce the risk of multiple disorders such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), allergy and colorectal cancer.


It is important to start taking probiotics early during antibiotic treatment. 

Efficiency of probiotic treatment decreases with every day of delay in taking probiotics.



Why should you use probiotics during an antibiotic course?

Antibiotics are among the most important drugs to combat infectious diseases. However, they do not only eliminate pathogens but also kill our beneficial bacteria, disrupting the microbial balance in our gut [1,2,3].    Probiotics are good bacteria that are beneficial for our health. They have been shown to diminish antibiotic-induced disturbances. [4,5,6,7].


During antibiotic use the affected gut microbiota enables pathogens to overgrow and cause the well-known side-effect of antibiotic use;  diarrhoea [8,9,10].   After a course of antibiotic, our friendly flora recovers but the original composition and diversity are not fully restored. Some bacterial groups do not even return at all [11,12,13].  Even when diarrhoea does not occur, antibiotics leave a permanent mark on our gut microbiota. These permanent disturbances have been linked to all kinds of health conditions such as inflammatory bowel diseases, obesity, irritable bowel syndrome, colon cancer and even allergies [14,15,16,17,18].  Particularly in vulnerable groups such as children, elderly and patients suffering from chronic diseases, antibiotics have a profound impact on health [19,20,21,22,23].   




European antibiotic day_1187

The B2B probiotic formulation Ecologic® AAD has been specifically developed for use during antibiotic use. More information about this probiotic 



Fortunately, antibiotic-induced disturbances can, to some extent, be prevented by taking specific multispecies probiotics. [24,25,26,27]. Probiotic bacteria help to maintain the microbial balance by;



 re-establishing the bacterial populations and their activity,

 inhibiting the growth of pathogenic bacteria,

 restoring the intestinal barrier function and regulating the immune system [28,29,30]. 


Their effect on reducing the risk of diarrhoea and preventing long-term disturbances have been proven in multiple studies [31,32,33]. What is more, probiotics come with no or negligible side-effects and their use has been proven safe even among vulnerable patient groups [34,35,36]. 


Prevention is better than cure. However, when antibiotics are deemed necessary, probiotics should be taken from the start of the antibiotic course to protect the microbiota against disturbances. Probiotic intake will immediately improve the patient’s quality of life by reducing the risk of diarrhoea, and will in the long-term prevent negative consequences for overall health.




1.     Jernberg C, Löfmark S, Edlund C, Jansson JK. Long-term impacts of antibiotic exposure on the human intestinal microbiota. Microbiology. 2010 Nov;156(Pt 11):3216-23

2.     Mangin I, Leveque C, Magne F, Suau A, Pochart P. Long-term changes in human colonic Bifidobacterium populations induced by a 5-day oral amoxicillin-clavulanic acid treatment. PLoS One 2012;7:e50257.

3.     Goldenberg JZ, et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev. 2015 Dec 22;(12):CD004827.

4.     Blaser M. Antibiotic overuse: Stop the killing of beneficial bacteria. Nature 2011;476:393-4.

5.     Ouwehand AC, Forssten S, Hibberd AA, Lyra A, Stahl B. Probiotic approach to prevent antibiotic resistance. Ann Med. 2016;48(4):246-55.

6.     Ouwehand AC, DongLian C, Weijian X, Stewart M, Ni J, Stewart T, et al. Probiotics reduce symptoms of antibiotic use in a hospital setting: a randomized dose response study. Vaccine. 2014;32:458–63

7.     Pattani R, et al. Probiotics for the prevention of antibiotic-associated diarrhea and Clostridium difficile infection among hospitalized patients: systematic review and meta-analysis. Open Medicine 2013;7 (2):31-9.

8.     Hempel S, Newberry SJ, Maher AR, Wang Z, Miles JN, Shanman R, Johnsen B, Shekelle PG. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. JAMA. 2012 May 9;307(18):1959-69.

9.     McFarland LV. Epidemiology, risk factors and treatments for antibiotic-associated diarrhea. Dig Dis. 1998;16:292–307.

10.   Videlock EJ1, Cremonini F. Meta-analysis: probiotics in antibiotic-associated diarrhoea. Aliment Pharmacol Ther. 2012 Jun;35(12):1355-69

11.   Dethlefsen L, Huse S, Sogin ML, Relman DA. The pervasive effects of an antibiotic on the human gut microbiota, as revealed by deep 16S rRNA sequencing. PLoS Biol. 2008;6:e280

12.   Rashid MU, Zaura E, Buijs MJ, Keijser BJ, Crielaard W, Nord CE, et al. Determining the long-term effect of antibiotic administration on the human normal intestinal microbiota using culture and pyrosequencing methods. Clin Infect Dis. 2015;60:S77–84 1

3.   Zaura E, Brandt BW, Teixeira de Mattos MJ, Buijs MJ, Caspers MP, Rashid MU, et al. Same exposure but two radically different responses to antibiotics: resilience of the salivary microbiome versus long-term microbial shifts in feces. mBio. 2015;6:e01693–15.

14.   Young VB, Schmidt TM. Antibiotic-associated diarrhea accompanied by large-scale alterations in the composition of the fecal microbiota. J Clin Microbiol. 2004;42:1203–6.

15.   Cani PD, Delzenne NM. The role of the gut microbiota in energy metabolism and metabolic disease. Curr Pharm Des. 2009;15:1546–58.

16.   Angelakis E, Million M, Kankoe S, et al. Abnormal weight gain and gut microbiota modifications are side effects of long-term doxycycline and hydroxychloroquine treatment. Antimicrob Agents Chemother 2014;58:3342-7.

17.   Hoskin-Parr L, Teyhan A, Blocker A, Henderson AJ. Antibiotic exposure in the first two years of life and development of asthma and other allergic diseases by 7.5 yr: a dose-dependent relationship. Pediatr Allergy Immunol 2013;24:762-71.

18.   Ianiro G, Tilg H, Gasbarrini A. Antibiotics as deep modulators of gut microbiota: between good and evil. Gut. 2016 Nov;65(11):1906-1915.

19.   Nobel YR, Cox LM, Kirigin FF, Bokulich NA, Yamanishi S, Teitler I, et al. Metabolic and metagenomic outcomes from early-life pulsed antibiotic treatment. Nat Commun. 2015;6:7486.

20.   Saari A, Virta LJ, Sankilampi U, Dunkel L, Saxen H. Antibiotic exposure in infancy and risk of being overweight in the first 24 months of life. Pediatrics. 2015;135:617–26.

21.   Greenwood C, Morrow AL, Lagomarcino AJ, et al. Early empiric antibiotic use in preterm infants is associated with lower bacterial diversity and higher relative abundance of Enterobacter. J Pediatr 2014;165:23-9.

22.   O'Sullivan O, Coakley M, Lakshminarayanan B, et al. Alterations in intestinal microbiota of elderly Irish subjects post-antibiotic therapy. J Antimicrob Chemother 2013;68:214-21.

23.   Rutten NB, Rijkers GT, Meijssen CB, Crijns CE, Oudshoorn JH, van der Ent CK, Vlieger AM. Intestinal microbiota composition after antibiotic treatment in early life: the INCA study. BMC Pediatr. 2015 Dec 9;15:204.

24.   Koning CJ, Jonkers DM, Stobberingh EE, Mulder L, Rombouts FM, Stockbrügger RW. The effect of a multispecies probiotic on the intestinal microbiota and bowel movements in healthy volunteers taking the antibiotic amoxycillin. Am J Gastroenterol. 2008 Jan;103(1):178-89.

25.   Koning C.J.M. Multispecies probiotics and antibiotics-associated side effects. PhD Thesis. 2010.

26.   Lang FC, et al. Use of a multispecies probiotic for the prevention of antibiotic associated diarrhea. Nutrafoods 2010;9(2):27-31.

27.   Hell M, Bernhofer C, Stalzer P, Kern JM, Claassen E. Probiotics in Clostridium difficile infection: reviewing the need for a multistrain probiotic.Benef Microbes. 2013 Mar 1;4(1):39-51.

28.   Guarner F, Malagelada JR. Gut flora in health and disease. The Lancet. 2003;361(9356):512–519.

29.    Isolauri E, Sütas Y, Kankaanpää P, Arvilommi H, Salminen S. Probiotics: effects on immunity. American Journal of Clinical Nutrition. 2001;73(2):444S–450S.

30.   Braon P.A, Kleerebezem M, Brummer RJ, Cani PD, Mercenier A, MacDonald TT, Garcia-Ródenas CL,Wells Can probiotics modulate human disease by impacting intestinal barrier function?JM. Br J Nutr. 2017 Jan 14; 117(1): 93–107.

31.   Goldenberg JZ, Ma SS, Saxton JD, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children. Cochrane Database Syst Rev 2013;5:CD006095.

32.   Engelbrektson A, Korzenik JR, Pittler A, Sanders ME, Klaenhammer TR, Leyer G, et al. Probiotics to minimize the disruption of faecal microbiota in healthy subjects undergoing antibiotic therapy. J Med Microbiol. 2009;58:663-70.

33.   Rehman A, Heinsen FA, Koenen ME, Venema K, Knecht H, Hellmig S, et al. Effects of probiotics and antibiotics on the intestinal homeostasis in a computer controlled model of the large intestine. BMC Microbiol. 2012;12:47.

34.   EFSA. Panel on Biological Hazards (BIOHAZ); Scientific Opinion on the maintenance of the list of QPS microorganisms intentionally added to food or feed (2009 update). EFSA J. 2009;7:92.

35.   van den Nieuwboer M, Brummer RJ, Guarner F, Morelli L, Cabana M, Claassen E. Safety of probiotics and synbiotics in children under 18 years of age. Benef Microbes. 2015;6(5):615-30.

36.    Van den Nieuwboer M, Brummer RJ, Guarner F, Morelli L, Cabana M, Claasen E. The administration of probiotics and synbiotics in immune compromised adults: is it safe? Benef Microbes. 2015 Mar;6(1):3-17. 




European antibiotic day

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