In recent decades the gut microbiome has emerged as a genuine functional organ, involved not only in digestion but also in the regulation of metabolic and immune functions1.
It is now well known that several commonly used medicines – from beta-blockers to antidepressants, through to proton pump inhibitors (PPIs) – can modify the intestinal microbial composition, with effects that may persist for years after the therapy has been discontinued.2
So it is not just antibiotics: molecules prescribed on a daily basis for hypertension, anxiety, insomnia and reflux can also influence the intestinal ecosystem2.
This does not imply that they need to be stopped, given their well-established clinical benefits. It is, however, advisable to use them appropriately, at the minimum effective dose and strictly for as long as necessary.
In this article we will analyse the action of probiotics on the gut microbiota and the scientific evidence supporting their use during prolonged drug therapies.
Action of probiotics on the gut microbiota
When a drug treatment alters the microbiota, strategies such as probiotics, a balanced diet rich in fibre and based on whole foods3, together with a reduction in stress4, can promote intestinal balance.
The International Scientific Association for Probiotics and Prebiotics defines probiotics as “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host”. Their effect is exerted through several mechanisms: inhibition of intestinal pathogens, production of bioactive metabolites, the reduction of luminal pH in the colon5.
The presence of specific clinical conditions or of prolonged drug therapies may call for long periods of supplementation in order to preserve the physiological composition of the gut microbiota.
In the next section we will present some studies carried out on patients undergoing prolonged drug treatment.
Probiotics and prolonged drug therapies: scientific evidence
In a randomised, double-blind, placebo-controlled trial6, 30 healthy adults were given a proton pump inhibitor (PPI, n = 15) or a placebo (n = 15) for 6 weeks.
The study assessed the impact of PPI intake and of the subsequent supplementation with multi-strain probiotics by means of shotgun metagenomic sequencing and faecal metabolomic analyses.
The drug treatment and the resulting lowering of pH led to a significant increase in bacterial families such as Streptococcaceae, Leuconostocaceae and Pasteurellaceae, strains often associated with dysbiosis and negative symptoms, along with metabolic changes (an increase in Gly-Arg-Val and phenylacetic acid).
Probiotic supplementation attenuated these alterations by reducing, for example, the expansion of the Leuconostocaceae and increasing beneficial metabolites such as 1H-indole-4-carbaldehyde. Furthermore, the acid suppression induced by the PPIs favoured a better colonisation by the probiotic strains, including Streptococcus thermophilus. This result shows how gastric acidity is a highly limiting factor for the colonisation of microorganisms, both probiotic and pathogenic.
The conclusion of this study highlights how combining probiotics with proton pump inhibitor therapy can not only attenuate the alterations of the microbial balance induced by the drug, but can also enhance its beneficial effects on the microbiota, promoting the stability and functionality of the intestinal ecosystem.
A further example7 of the impact of probiotics on microbial rebalancing comes from a randomised clinical study carried out on patients with hyperlipidaemia. Thirty-three subjects were assigned to a probiotic group ( Lactobacillus casei Zhang, Bifidobacterium animalis subsp. lactis V9, Lactobacillus plantarum P-8 ) or to a control group (n=15), both on atorvastatin therapy. Serum and faecal samples were collected for the subsequent analyses.
After 3 months of treatment, the probiotic group showed a greater intestinal microbial abundance and a significant improvement in the composition of the microbiota, with an increase in Bifidobacterium, Lactobacillus and Akkermansia and a reduction in potentially harmful taxa such as Escherichia, Eggerthella and Sutterella. The probiotics helped to optimise the structure of the gut microbiota, suggesting a beneficial effect complementary to drug therapy in the support of patients with hyperlipidaemia.
This evidence suggests that combining probiotics may represent a valid strategy to mitigate the dysbiosis induced by prolonged drug therapies.
With this in mind, the formula of Probiogea Intestino Salugea has been developed with strains suitable for prolonged use, so as to support the functionality and stability of the microbiota on an ongoing basis.
Probiogea Intestino: balance of the intestinal bacterial flora during drug therapies
The formula of Probiogea Intestino Salugea includes a combination of probiotics selected to support the balance of the bacterial flora and intestinal wellbeing. The strains it contains are:
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Bifidobacterium longum
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Bacillus coagulans
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Saccharomyces boulardii
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Chicory inulin
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Patented probiotic blend SynbÆctive® SmilinGut8
(Lactiplantibacillus plantarum PBS067, Lacticaseibacillus rhamnosus LRH020, Bifidobacterium animalis subsp. lactis BL050).
The acid-resistant vegetable capsules ensure the survival of the probiotics during gastric transit, allowing them to reach the intestine, adhere to the mucosa and contribute to microbial colonisation.
The formulation, also suitable for vegans and vegetarians, is free from gluten, lactose, GMOs, preservatives and synthetic additives.
The bottle in pharmaceutical-grade dark glass, combined with the reusable safety seal under the cap, ensures optimal protection over time, preserving the product from light, heat, humidity and contamination.
The composition of Probiogea Intestino Salugea9 provides bifidobacteria, lactobacilli and yeasts typical of a balanced microbiota, combined with a patented probiotic blend whose efficacy is documented by scientific evidence.
The bottle contains 60 acid-resistant capsules, which can be used in the following ways:
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Rapid response: 1 capsule in the middle of the morning and 1 in the middle of the afternoon, away from meals.
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Alongside prolonged drug therapies: 1 capsule a day, away from meals, making it possible to cover two months of supplementation with a single bottle.
The dosage can be adjusted according to individual needs and to the clinical picture.
In conclusion, considering how diet, stress and prolonged drug therapies can affect the stability of the microbiota, a carefully calibrated formulation such as the one contained in Probiogea Intestino can represent a valid support to preserve its balance.
The combination of selected strains, the resistance to gastric transit and the suitability for continuous use make it a valid tool to support intestinal wellbeing even in the clinical contexts most prone to dysbiosis.