Bifidobacterium longum

Usage

• Bifidobacterium longum is primarily used as a probiotic, a type of “good” bacteria, to support and supplement the gut’s natural flora. It is often used to address various gastrointestinal issues, such as antibiotic-associated diarrhea, infant colic, and constipation. It has also shown promise in managing eczema in infants when administered to breastfeeding mothers. Other potential uses include improving athletic performance, alleviating lactose intolerance, and preventing certain infections, but further research is needed to confirm these benefits.

• Pharmacological Classification: Probiotic (Biological Agent)

• Mechanism of Action: B. longum primarily works by competitively excluding pathogenic bacteria in the gut lumen and intestinal mucosa, by modulating the immune system response, and by modifying the intestinal microbiota to maintain the integrity of the gut mucosal barrier. It also produces lactic and acetic acid, which help maintain a healthy gut pH and promote optimal digestion.

Alternate Names

• B. longum

• Bifidobacterium longum subsp. infantis (a subspecies commonly found in infants)

• Bifidobacterium longum subsp. longum (a subspecies commonly found in adults)

• Brand Names: This probiotic is included in various multi-strain probiotic formulations and is available as single-strain supplements from several brands. Brand names may vary regionally; examples include Culturelle and Align.

How It Works

• Pharmacodynamics: B. longum produces lactic and acetic acid, contributing to a lower intestinal pH. This acidic environment inhibits the growth of many harmful bacteria. It also modulates immune responses, reducing inflammation and supporting gut barrier integrity. Specific strains, like BB536, influence glucose metabolism and may help regulate blood sugar levels. B. longum enhances the gut microbiome diversity, leading to improved digestion and nutrient absorption.

• Pharmacokinetics: Primarily administered orally. It colonizes the gastrointestinal tract, but is not absorbed systemically. Persistence in the gut is dependent on continuous intake, as it does not permanently colonize. Elimination primarily occurs through fecal excretion. It may also undergo metabolism by other gut microbes.

• Mode of Action: At the cellular level, B. longum competes with pathogenic bacteria for adhesion sites on the intestinal wall. This prevents harmful bacteria from colonizing and causing infections. Specific strains, like BB536, may interact with receptors on immune cells, influencing their activity.

• Receptor Binding/Enzyme Inhibition: Limited information available. B. longum does not directly inhibit enzymes or modulate neurotransmitters like traditional drugs. The primary mechanism is competitive exclusion, modulation of the gut microenvironment, and boosting local immunity.

• Elimination Pathways: Eliminated mainly through feces, with some bacterial cells potentially undergoing metabolism by other members of the gut microbiota.

Dosage

Standard Dosage

Adults:

• 10-20 billion CFU (colony-forming units) daily, preferably taken with food. Higher doses (20-50 billion CFUs) might be considered for specific health conditions. For antibiotic-associated diarrhea, up to 20 billion CFUs daily for up to 8 weeks has been studied. The dosage might also be affected by the specific strain used.

Children:

• General guideline: Up to 6 years: 1/4 of the adult dose; 6-12 years: 1/2 of the adult dose; teens: full adult dose. It’s crucial to consult with a healthcare professional for precise pediatric dosing, which may depend on the specific formulation and the child’s condition.

Special Cases:

• Elderly Patients: Start with the standard adult dose and adjust as needed based on individual tolerance and health status. Monitor closely for gastrointestinal side effects like bloating and gas.

• Patients with Renal Impairment: No specific dosage adjustments for renal impairment are typically required, as it is not systemically absorbed.

• Patients with Hepatic Dysfunction: Similar to renal impairment, dose adjustment for hepatic dysfunction is not typically needed due to its localized action in the gut. However, caution is advised, and monitoring is important.

• Patients with Comorbid Conditions: Exercise caution in patients with significantly weakened immune systems, as there is a theoretical risk of systemic infection. Individualized assessment and consultation with an immunologist may be necessary.

Clinical Use Cases:

• Dosage for specific clinical settings (intubation, surgical procedures, mechanical ventilation, ICU use, emergency situations) has not been established. Use in these settings should be guided by clinical judgment and patient-specific factors, with careful monitoring.

Dosage Adjustments:

• Adjust dosage based on individual responses, tolerability, and the specific medical condition. Close monitoring is essential, particularly in vulnerable populations.

Side Effects

Common Side Effects:

• Increased gas (flatulence)
• Abdominal bloating

Rare but Serious Side Effects:

• Systemic infection (extremely rare, primarily in severely immunocompromised individuals)

Long-Term Effects:

• Limited data are available on long-term effects. Continuous or prolonged use should be evaluated based on individual benefits and risks.

Adverse Drug Reactions (ADR):

• Allergic reactions (rare)

Contraindications

• Severe immunodeficiency requiring immunosuppressive therapy.
• Individuals with short bowel syndrome or other conditions with significantly compromised gut barrier integrity should be evaluated cautiously.

Drug Interactions

• Antibiotics: Antibiotics can reduce the effectiveness of B. longum. Take probiotics at least 2-3 hours before or after antibiotics.
• Antifungals: Concurrent use with antifungals like clotrimazole, ketoconazole, griseofulvin, or nystatin may theoretically reduce the effectiveness of B. longum.
• Immunosuppressants: Use with caution, as immunosuppressants can further increase the risk of infection in already vulnerable individuals.

Pregnancy and Breastfeeding

• Pregnancy Safety Category: Generally considered safe during pregnancy. Studies have shown safe use throughout pregnancy and up to two months postpartum during breastfeeding.

• Fetal Risks: No known adverse fetal effects have been reported.

• Drug excretion in breast milk: Limited data, but its presence in breast milk contributes to infant gut colonization with beneficial bacteria.

Drug Profile Summary

• Mechanism of Action: Competitive exclusion of pathogens, modulation of the gut microenvironment, support of gut barrier integrity.
• Side Effects: Generally well-tolerated; mild bloating and gas may occur.
• Contraindications: Severe immunodeficiency.
• Drug Interactions: Antibiotics, antifungals, immunosuppressants.
• Pregnancy & Breastfeeding: Generally safe.
• Dosage: Adults: 10-20 billion CFUs daily; children: dose adjusted by age; special populations: dose adjustment based on health status.
• Monitoring Parameters: Monitor for gastrointestinal tolerance (bloating, gas), and any signs of infection.

Popular Combinations:

• Often combined with other probiotic strains, such as Lactobacillus and Streptococcus species, for broader synergistic effects on gut health. Prebiotics, such as galacto-oligosaccharides (GOS), may also be added to enhance the growth of B. longum.

Precautions

• General Precautions: Although generally considered safe, assess for any history of allergies or sensitivities.
• Specific Populations (Pregnant Women, Breastfeeding Mothers, Children, Elderly): B. longum is generally safe for these populations, but dosage considerations may apply. Use cautiously in severely immunocompromised individuals.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Bifidobacterium longum?

A: For adults, the standard dosage is 10-20 billion CFUs daily, taken with food. Pediatric dosages are adjusted based on age, and higher doses may be considered for specific health conditions.

Q2: Is Bifidobacterium longum safe during pregnancy?

A: Yes, it is generally considered safe to take during pregnancy and while breastfeeding.

Q3: What are the common side effects of B. longum?

A: The most common side effects are mild and include increased gas and bloating.

Q4: How does B. longum interact with antibiotics?

A: Antibiotics can reduce the effectiveness of B. longum. Take B. longum at least 2-3 hours apart from antibiotics.

Q5: Can B. longum help with constipation?

A: Yes, studies suggest that B. longum, especially strain BB536, can help improve bowel regularity and relieve constipation.

Q6: What is the difference between B. longum subsp. infantis and B. longum subsp. longum?

A: These are subspecies of B. longum. Infantis is predominantly found in the gut of infants, particularly those who are breastfed, while longum is prevalent in adults.

Q7: Can B. longum help prevent eczema in infants?

A: Studies indicate that maternal supplementation with B. longum during pregnancy and breastfeeding may reduce the risk of eczema in infants.

Q8: Are there any contraindications for using B. longum?

A: Individuals with severe immunodeficiency, short bowel syndrome, or significantly compromised gut barrier integrity should use B. longum with extreme caution.

Q9: How should B. longum be stored?

A: B. longum products often require refrigeration to maintain the viability of the live bacteria. Follow manufacturer’s instructions for storage.

Q10: Is B. longum the same as yogurt or kefir?

A: No, although yogurt and kefir may contain B. longum and other probiotics, they are fermented food products, not specifically the bacterium itself. Probiotic supplements offer a more concentrated and standardized source of the bacteria.