Usage
- Lactobacillus reuteri is primarily used as a probiotic to improve gut health. It’s prescribed for conditions like infantile colic, regurgitation, acute diarrhea, and antibiotic-associated diarrhea. It may also be used to alleviate symptoms of lactose intolerance and eczema. Some studies suggest potential benefits for constipation and overall digestive health.
- Pharmacological classification: Probiotic (biological agent).
- Mechanism of Action: L. reuteri exerts its effects through various mechanisms, including competitive exclusion of pathogenic bacteria, production of antimicrobial substances (like reuterin), modulation of the immune system, and strengthening of the intestinal barrier.
Alternate Names
- BioGaia (a common brand name)
How It Works
- Pharmacodynamics: L. reuteri competes with pathogenic bacteria for resources and adhesion sites in the gut. It produces reuterin, which inhibits the growth of various harmful microorganisms. It also modulates the immune system, potentially reducing inflammation and promoting gut barrier integrity.
- Pharmacokinetics: Administered orally, L. reuteri colonizes the gastrointestinal tract. Survival through the acidic stomach environment varies among strains. The duration of colonization is also variable. Elimination occurs primarily through fecal excretion.
- Mode of Action: Specific mechanisms include competitive exclusion, production of antimicrobial substances (reuterin), immunomodulation (e.g., affecting cytokine production), and enhancement of intestinal barrier function.
- Receptor binding, enzyme inhibition, or neurotransmitter modulation: While specific receptor interactions or enzyme inhibition haven’t been extensively characterized, L. reuteri influences immune responses, suggesting interactions with immune cells and their receptors. Some evidence points to modulation of neurotransmitters involved in gut motility.
- Elimination pathways: Primarily fecal excretion; some metabolic byproducts may be absorbed and further metabolized or excreted via urine.
Dosage
Standard Dosage
Adults:
- 5 drops (containing 100 million CFU of L. reuteri DSM 17938) once daily. Dosages may vary based on the specific indication or product formulation. Some studies used doses ranging from 1 x 10⁸ to 4 x 10⁸ CFU/day for 5-7 days in cases of acute diarrhea.
Children:
- 5 drops (containing 100 million CFU of L. reuteri DSM 17938) once daily for colic, constipation, regurgitation, and eczema. Similar dosing may be used in pediatric acute diarrhea, with some studies using 2 x 10⁸ CFU/day for 5 days or 4 x 10⁸ CFU/day for 7 days.
- Pediatric Safety Considerations: Generally considered safe for pediatric use; monitor for any adverse reactions.
Special Cases:
- Elderly Patients: No specific dosage adjustments are typically required, but it’s important to consider overall health status and comorbidities.
- Patients with Renal Impairment: No specific adjustments based on renal impairment are established.
- Patients with Hepatic Dysfunction: No specific adjustments based on hepatic dysfunction are established.
- Patients with Comorbid Conditions: Consider any underlying conditions and potential drug interactions.
Clinical Use Cases
- Data for the specific clinical settings listed (intubation, surgical procedures, mechanical ventilation, ICU use, emergency situations) regarding L. reuteri use are limited. Probiotic use in these situations is typically individualized based on patient needs and clinical judgment.
Dosage Adjustments:
- Dosage adjustments might be needed based on patient-specific factors such as the severity of the condition, response to treatment, and tolerance. Further research is needed to establish specific dosage adjustments based on renal/hepatic function, metabolic disorders, or genetic polymorphisms.
Side Effects
Common Side Effects:
- Generally well-tolerated; mild gastrointestinal symptoms such as flatulence or bloating may occur.
Rare but Serious Side Effects:
- Cases of sepsis have been reported, particularly in immunocompromised individuals.
Long-Term Effects:
- Limited data on long-term effects; generally considered safe for prolonged use in healthy individuals.
Adverse Drug Reactions (ADR):
- Allergic reactions are possible, though rare.
Contraindications
- Hypersensitivity to L. reuteri or any components of the formulation.
- Use with caution in severely immunocompromised patients due to the theoretical risk of infection.
Drug Interactions
- Limited information on specific drug interactions. Concomitant use with antibiotics may reduce the effectiveness of L. reuteri.
Pregnancy and Breastfeeding
- Generally considered safe during pregnancy and breastfeeding. However, it’s always best to consult with a healthcare professional before using any medication or supplement during these periods.
Drug Profile Summary
- Mechanism of Action: Competitive exclusion, reuterin production, immunomodulation, enhanced gut barrier function.
- Side Effects: Generally well-tolerated; mild GI symptoms possible. Rare cases of sepsis reported.
- Contraindications: Hypersensitivity, severe immunocompromise.
- Drug Interactions: Limited data; potential interaction with antibiotics.
- Pregnancy & Breastfeeding: Generally considered safe.
- Dosage: Adults/Children: 5 drops (100 million CFU) daily. Dosages may vary based on specific products and indications.
- Monitoring Parameters: Monitor for improvement of symptoms, resolution of diarrhea, or reduction in colic episodes.
Popular Combinations
- L. reuteri is sometimes combined with other probiotics or prebiotics for synergistic effects. Specific combinations and their clinical benefits require further research.
Precautions
- General Precautions: Assess for any allergies or underlying health conditions.
- Specific Populations: Consult a healthcare provider before use in immunocompromised individuals.
- Lifestyle Considerations: No specific lifestyle restrictions are generally associated with L. reuteri use.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Lactobacillus reuteri?
A: The typical dosage is 5 drops (100 million CFU) once daily, but dosages can vary based on the formulation and the targeted condition.
Q2: Is Lactobacillus reuteri safe for infants?
A: Generally considered safe for infants, and it’s often used to treat colic and regurgitation.
Q3: How does Lactobacillus reuteri work in cases of diarrhea?
A: It helps restore the balance of gut flora, competes with pathogenic bacteria, and may produce antimicrobial substances like reuterin.
Q4: Can Lactobacillus reuteri be used with antibiotics?
A: While it might help with antibiotic-associated diarrhea, concomitant administration may reduce the effectiveness of L. reuteri. Staggering the doses might be beneficial.
Q5: Are there any side effects associated with Lactobacillus reuteri?
A: Generally well-tolerated, but mild gastrointestinal issues like flatulence or bloating might occur. Rare cases of sepsis have been reported, especially in immunocompromised individuals.
Q6: Can pregnant or breastfeeding women take Lactobacillus reuteri?
A: It’s generally considered safe during pregnancy and breastfeeding, but consulting a healthcare provider is always recommended.
Q7: How long does it take for Lactobacillus reuteri to work?
A: The onset of effects can vary depending on the individual and the specific condition being treated. Some individuals may experience benefits within a few days, while others may take longer.
Q8: Can Lactobacillus reuteri help with lactose intolerance?
A: Some studies suggest it may help reduce symptoms of lactose intolerance, potentially by improving lactose digestion.
Q9: Are there any drug interactions I should be aware of with Lactobacillus reuteri?
A: Limited data is available on specific drug interactions. Concomitant use with antibiotics might reduce the probiotic’s effectiveness.
