Antibiotic-perturbed microbiota and the role of probiotics

Hania Szajewska; Karen P Scott; Tim de Meij; Sofia K Forslund-Startceva; Rob Knight; Omry Koren; Paul Little; Bradley C Johnston; Jan Łukasik; Jotham Suez; Daniel J Tancredi; Mary Ellen Sanders

doi:10.1038/s41575-024-01023-x

Antibiotic-perturbed microbiota and the role of probiotics

Nat Rev Gastroenterol Hepatol. 2024 Dec 11. doi: 10.1038/s41575-024-01023-x. Online ahead of print.

Authors

Hania Szajewska^#¹, Karen P Scott^#², Tim de Meij³, Sofia K Forslund-Startceva^{4

5

6

7}, Rob Knight^{8

9

10

11

12}, Omry Koren¹³, Paul Little¹⁴, Bradley C Johnston^{15

16}, Jan Łukasik¹, Jotham Suez¹⁷, Daniel J Tancredi¹⁸, Mary Ellen Sanders¹⁹

Affiliations

¹ Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland.
² Rowett Institute, University of Aberdeen, Aberdeen, UK.
³ Department of Paediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, Academic Medical Centre, Amsterdam, The Netherlands.
⁴ Experimental and Clinical Research Center, a joint cooperation of Max Delbruck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany.
⁵ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
⁶ Max Delbruck Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.
⁷ DZHK (German Centre for Cardiovascular Research), Berlin, Germany.
⁸ Department of Pediatrics, University of California San Diego, San Diego, CA, USA.
⁹ Department of Computer Science & Engineering, University of California San Diego, San Diego, CA, USA.
¹⁰ Shu Chien - Gene Lay Department of Bioengineering, University of California San Diego, San Diego, CA, USA.
¹¹ Halıcıoğlu Data Science Institute, University of California San Diego, San Diego, CA, USA.
¹² Center for Microbiome Innovation, University of California San Diego, San Diego, CA, USA.
¹³ Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
¹⁴ Primary Care Research Centre, University of Southampton, Southampton, UK.
¹⁵ Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, USA.
¹⁶ Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA.
¹⁷ W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
¹⁸ Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, CA, USA.
¹⁹ International Scientific Association for Probiotics and Prebiotics, Consulting Scientific Advisor, Centennial, CO, USA. [email protected].

^# Contributed equally.

PMID: 39663462
DOI: 10.1038/s41575-024-01023-x

Abstract

The disruptive effect of antibiotics on the composition and function of the human microbiota is well established. However, the hypothesis that probiotics can help restore the antibiotic-disrupted microbiota has been advanced, with little consideration of the strength of evidence supporting it. Some clinical data suggest that probiotics can reduce antibiotic-related side effects, including Clostridioides difficile-associated diarrhoea, but there are no data that causally link these clinical effects to microbiota protection or recovery. Substantial challenges hinder attempts to address this hypothesis, including the absence of consensus on the composition of a 'normal' microbiota, non-standardized and evolving microbiome measurement methods, and substantial inter-individual microbiota variation. In this Review, we explore these complexities. First, we review the known benefits and risks of antibiotics, the effect of antibiotics on the human microbiota, the resilience and adaptability of the microbiota, and how microbiota restoration might be defined and measured. Subsequently, we explore the evidence for the efficacy of probiotics in preventing disruption or aiding microbiota recovery post-antibiotic treatment. Finally, we offer insights into the current state of research and suggest directions for future research.

Publication types

Review