Lactic acid bacillus

Usage

• Lactic acid bacillus (LAB), a probiotic, is primarily used to treat diarrhea, particularly antibiotic-associated diarrhea. It helps restore the balance of gut flora disrupted by infection or antibiotics. Other uses include:
  • Improving lactose intolerance
  • Relieving symptoms of irritable bowel syndrome (IBS)
  • Supporting general gut health and immunity.
  • Treating Clostridium difficile infections (CDI), acute infectious diarrhea, and necrotizing enterocolitis
  • Preventing antibiotic-associated diarrhea
• Pharmacological classification: Probiotic, Antidiarrheal
• Mechanism of action: LAB produces lactic acid, which lowers the pH in the intestines, creating an environment unfavorable for the growth of many harmful bacteria. It also competes with pathogenic bacteria for resources and may stimulate the immune system. Some strains produce bacteriocins with antimicrobial activity.

Alternate Names

• Lactobacillus species (e.g., Lactobacillus acidophilus, Lactobacillus rhamnosus, Lactobacillus casei, etc.)
• LAB (abbreviation)
• Doderlein’s bacillus
• Various brand names exist depending on the specific strain and formulation (e.g., Culturelle, Lacidofil, Bioflor).

How It Works

• Pharmacodynamics: LAB primarily exerts its effects by altering the gut microbiome. The production of lactic acid lowers intestinal pH, inhibiting the growth of certain pathogenic bacteria. Specific strains might also enhance immune responses, modulate inflammation, and produce vitamins.
• Pharmacokinetics: Orally administered LAB mostly remains within the gastrointestinal tract. A small fraction may be absorbed into the bloodstream, but the primary effect is local in the gut. The bacteria are not metabolized by human enzymes but can be broken down by other gut microbes. Elimination occurs through feces.
• Mode of action:
  • Production of lactic acid, lowering intestinal pH
  • Production of bacteriocins
  • Competition with pathogens for nutrients and adhesion sites
  • Enhancement of gut barrier function
  • Modulation of the immune system
• The elimination pathway is mainly through excretion in the feces.

Dosage

Standard Dosage

Adults: 1-60 billion CFU/day, divided into 1-4 doses, depending on the indication and specific product. The typical recommendation is 1-2 capsules or tablets once or twice a day or as directed by a healthcare professional. It is recommended to maintain a consistent daily intake.

Children: Dosing in children varies depending on age, weight, and formulation. It is crucial to follow product-specific guidelines. Some manufacturers recommend against use in children under 3 years unless under medical supervision. Doses up to 30 billion CFU daily have been used for up to 3 months. Infants might receive doses based on weight (e.g., 10 million spores/kg body weight).

Special Cases:

• Elderly Patients: No specific dose adjustments are typically necessary, but starting with a lower dose and monitoring for tolerance might be advisable.
• Patients with Renal Impairment: No specific dose adjustments are usually necessary, but careful monitoring is important.
• Patients with Hepatic Dysfunction: Dose adjustments may not be necessary but the patients should be closely monitored.
• Patients with Comorbid Conditions: Consider underlying medical conditions, especially immunodeficiency, which may increase the risk of adverse effects. Patients with severe conditions like HIV/AIDS should exercise caution and seek medical advice.

Clinical Use Cases

Dosing for these cases generally follows the standard adult or pediatric recommendations, adjusted based on individual patient needs and disease severity. The duration of treatment varies depending on the indication and clinical response.

• Intubation: Prophylactic use might be considered to prevent ventilator-associated pneumonia.
• Surgical Procedures: Perioperative use might be considered to support gut health and reduce postoperative complications.
• Mechanical Ventilation: To prevent ventilator-associated complications.
• Intensive Care Unit (ICU) Use: May be helpful in preventing or treating diarrhea and other gastrointestinal complications in critically ill patients.
• Emergency Situations: Not typically used in immediate emergency situations.

Dosage Adjustments

Dose modifications might be necessary based on individual patient response and tolerance. Always follow product-specific recommendations and consult with a healthcare professional.

Side Effects

Common Side Effects

• Mild bloating
• Intestinal gas (flatulence)

Rare but Serious Side Effects

• Infections (especially in immunocompromised individuals)
• Allergic reactions (rare)

Long-Term Effects

Long-term effects are generally not expected with LAB use, but continuous monitoring is recommended.

Adverse Drug Reactions (ADR)

Clinically significant ADRs are rare. Seek immediate medical attention if severe allergic reactions or signs of infection develop.

Contraindications

• Known hypersensitivity to any component of the product.
• Patients with severely weakened immune systems (e.g., HIV/AIDS, organ transplant recipients) should exercise caution and consult their healthcare provider.
• Premature infants, especially in the NICU.

Drug Interactions

• Antibiotics: Antibiotics may reduce the effectiveness of LAB. Take LAB at least 2 hours before or after antibiotics.
• Immunosuppressants: LAB may interact with immunosuppressants. Consult a doctor before use if you are on immunosuppressants like steroids.
• Alcohol: Avoid alcohol consumption while using LAB, as its interaction with the probiotic is unknown.
• Consider potential interactions with medications metabolized by CYP450 enzymes, although limited data are available.

Pregnancy and Breastfeeding

LAB is generally considered safe during pregnancy and breastfeeding when taken orally. However, consult your doctor before starting or continuing use, especially if you have any underlying health conditions. It has been used safely, along with other probiotics, for up to 6 weeks, starting at 24-28 weeks of gestation. Lactic acid bacteria are naturally present in breast milk and contribute to the infant’s gut flora development.

Drug Profile Summary

• Mechanism of Action: Restores normal gut flora, produces lactic acid, may enhance immunity.
• Side Effects: Bloating, gas (rarely infections in immunocompromised individuals).
• Contraindications: Hypersensitivity, severe immunodeficiency, premature infants in NICU setting.
• Drug Interactions: Antibiotics, immunosuppressants. Alcohol interaction unknown.
• Pregnancy & Breastfeeding: Generally safe; consult with healthcare professional.
• Dosage: Varies based on strain, formulation, and indication; 1-60 billion CFU daily common for adults, divided doses. Up to 30 billion CFU daily in children.
• Monitoring Parameters: Monitor for gastrointestinal tolerance, resolution of symptoms, and potential adverse events.

Popular Combinations

• LAB is often combined with other probiotics or prebiotics in synbiotic formulations.
• It can also be administered with rehydration solutions for diarrhea management.
• It is sometimes combined with antibiotics or antidiarrheals for specific indications. However, timing of administration is essential to avoid reducing LAB efficacy.

Precautions

• General Precautions: Assess for allergies, immunocompromised states, and underlying health conditions.
• Specific Populations: Consult a healthcare provider for use during pregnancy and breastfeeding or in immunocompromised individuals. Use with caution in premature infants.
• Lifestyle Considerations: Alcohol interaction unknown. Smoking may worsen gastrointestinal conditions and reduce the benefits of probiotics.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Lactic acid bacillus?

A: The recommended dosage varies based on age, formulation, and indication. Adults commonly take 1-60 billion CFU per day, divided into multiple doses. Pediatric doses are lower and should be guided by product labeling and medical advice.

Q2: Is Lactic acid bacillus safe during pregnancy?

A: LAB is generally considered safe during pregnancy, however, consultation with a healthcare professional is recommended before use.

Q3: What are the common side effects of Lactic acid bacillus?

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

Q4: Can Lactic acid bacillus be taken with antibiotics?

A: It can, but it is recommended to administer LAB at least 2 hours before or after antibiotics to minimize the reduction in its effectiveness.

Q5: How long does it take for Lactic acid bacillus to work?

A: The onset of therapeutic effects varies depending on the indication. For diarrhea, improvement might be seen within a few days. For other conditions, benefits may take longer to manifest.

Q6: Are there any contraindications for Lactic acid bacillus?

A: Yes. Contraindications include known hypersensitivity to the product and caution should be used by severely immunocompromised patients and with premature infants in the NICU setting.

Q7: What are the drug interactions of Lactic acid bacillus?

A: Potential drug interactions include interactions with antibiotics and immunosuppressants. Alcohol usage should be avoided, as its interaction with LAB is unknown.

Q8: Are there any specific precautions for elderly patients?

A: No specific dose adjustments are usually recommended for the elderly. However, careful monitoring and starting with a lower dose are advisable.

Q9: What is the role of Lactic acid bacillus in infant gut health?

A: LAB is present in breast milk and plays a crucial role in establishing a healthy gut microbiome in infants, contributing to immune development and overall health.

Q10: Can Lactic acid bacillus be used in the ICU?

A: Yes, it may be used to prevent or treat gastrointestinal complications, such as diarrhea, in ICU patients. Consultation with a healthcare professional is recommended.