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Probiotics can prevent drug-induced gastrointestinal symptoms

EFSM: 2022;2:220009DOI: 10.52778/efsm.22.0009Publié le: 26.01.2022
Manuel Plomer et Marcos III Perez

Probiotics such as Bacillus clausii reduce the occurrence of gastrointestinal side effects of commonly used medications such as antibiotics and proton pump inhibitors in placebo-controlled randomized trials. Their use can make Helicobacter pylori eradication schemes more tolerable.

Antibiotics may disturb the physiological microbiome in the gut and can lead to diarrhea. Probiotics can prevent antibiotic-induced diarrhea as summarized by a review from the Cochrane Collaboration [1] and confirmed in recent large-scale studies [2]. However, antibiotics are not the only drug class to cause intestinal dysfunction. As highlighted in a recent systematic review [3], various other drug classes including proton pump inhibitors are associated with a decrease of diversity of the gut microbiome. For instance, proton pump inhibitors are linked to a decrease in Clostridiales and an increase in Actinomycetales, Micrococcaceae and Streptococcaceae, all are changes previously implicated in dysbiosis and increased susceptibility to Clostridioides difficile infection.


Against this background, two placebo-controlled, randomized, double-blind studies have evaluated the effects of the probiotic Bacillus clausii strains O/C, N/R, SIN and T against digestive side effects of Helicobacter pylori eradication treatment. The first of the two studies randomized 120 patients undergoing triple therapy with rabeprazole 20 mg twice daily, clarithromycin 500 mg twice daily and amoxicillin 1 g twice daily for 7 days to either receive placebo or B. clausii suspension thrice daily (total daily dose of 6 billion colony-forming units [CFU]) for 14 days starting on the first day of treatment [4]. Gastrointestinal side effects were recorded for 4 weeks from the start of therapy based on a validated questionnaire. A second study of similar design randomized 130 patients using similar inclusion criteria to receive placebo or B. clausii as capsule [5]. The main protocol difference was that the sample size in the second study was based on a power calculation and that it had a defined primary endpoint, i.e., occurrence of diarrhea in the first week.


B. clausii reduced the incidence of diarrhea to a clinically meaningful and statistically significant extent in the first week of treatment irrespective of differences in the incidence of diarrhea between the two studies (Fig. 1). Despite a lower incidence of diarrhea in the second week, the risk reduction by B. clausii was similar. Moreover, when diarrhea occurred in the B. clausii group, it was of shorter duration than in the placebo group. Regarding other outcome parameters, the Nista study found a reduction of epigastric pain in both weeks, whereas the Plomer trial made this observation only in the second week. Of note, H. pylori eradication rates were similar in the presence of placebo or B. clausii. We conclude that treatment with B. clausii compared to placebo reduces the incidence of the most common gastrointestinal side-effects related to H. pylori eradication triple treatment in symptom-free, H. pylori-positive subjects.


  1. Goldenberg JZ, Lytvyn L, Steurich J, Parkin P, et al. Probiotics for the prevention of pediatric antibiotic‐associated diarrhea. Cochrane Database of Systematic Reviews 2015 Dec 22;(12):CD004827.
  2. Greuter T, Michel MC, Thomann D, Weigmann H, Vavricka SR. Randomized, placebo-controlled, double-blind and open-label studies in the treatment and prevention of acute diarrhea with Enterococcus faecium SF68. Frontiers in Medicine 2020;7:276.
  3. Le Bastard Q, Al-Ghalith GA, Grégoire M, Chapelet G, et al. Systematic review: human gut dysbiosis induced by non-antibiotic prescription medications. Alimentary Pharmacology & Therapeutics 2018;47:332–45.
  4. Nista EC, Candelli M, Cremonini F, Cazzato IA, et al. Bacillus clausii therapy to reduce side-effects of anti-Helicobacter pylori treatment: randomized, double-blind, placebo controlled trial. Alimentary Pharmacology & Therapeutics 2004;20:1181–8.
  5. Plomer M, Perez M III, Greifenberg DM. Effect of Bacillus clausii capsules in reducing adverse effects associated with Helicobacter pylori eradication therapy: a randomized, double-blind, controlled trial. Infectious Diseases and Therapy 2020;9:867–78.


Conflict of interest: M. Plomer and M. III Perez are employees of Sanofi-Aventis.

Disclosure: Medical writing and publication funded by Sanofi-Aventis Deutschland GmbH.

Affiliation/Coordonnées de l'interlocuteur: Manuel Plomer, PhD, Sanofi-Aventis Deutschland GmbH, Industriepark Hoechst, 65926 Frankfurt am Main, Germany et Marcos III Perez, MD, Sanofi-Aventis Deutschland GmbH, Industriepark Hoechst, Frankfurt am Main, Germany
Soumis le: 25.10.2021Accepté le: 07.12.2021Publié le: 26.01.2022
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