While essential in treating bacterial infections, antibiotics can profoundly affect the gut microbiome. The human gut hosts trillions of microorganisms, including bacteria, archaea, viruses, and fungi, which collectively play a vital role in metabolism, immune modulation, maintaining gut barrier integrity, and many other essential functions[sup]4[/sup].

As antibiotics target bacterial cells indiscriminately, impacting both pathogenic and commensal species, they disrupt this delicate ecosystem, often leading to loss of microbiome diversity, opportunistic pathogenic overgrowth, dysbiosis, diarrhoea, and other gastrointestinal symptoms.

Antibiotic associated diarrhoea (AAD) can affect up to 1 in 3 people taking antibiotics[sup]1[/sup], depending on the antibiotic prescribed[sup]5[/sup], impacting both children and adults, with significant implications on overall well-being, including[sup]1-6[/sup]:

• Reduced quality of life
• Work absenteeism
• Early discontinuation leading to poor treatment outcomes and antibiotic resistance.

AAD typically starts 5 days after antibiotic therapy starts and can last between 2 to 41 days[sup]7[/sup].

A 2019 systematic review with meta-analysis published in the World Journal of Gastroenterology evaluated the effectiveness of LGG® supplementation in treating acute diarrhea in children. This review included 19 RCTs with a total of 4073 children[sup]11[/sup].

Those receiving LGG® had a significant reduction in duration of diarrhoea, and their risk of diarrhoea lasting more than 3 or 4 days was significantly reduced (OR 0.5 and 0.6 respectively).[sup]11[/sup]

In another RCT, LGG® supplementation was shown to significantly reduce antibiotic-associated GI side-effects in children, including[sup]6[/sup]:

• Incidence of diarrhoea by more than two thirds
• Duration of AAD by more than a day

LGG® supplementation was also associated with a significant reduction in the duration of hospital stay by almost a day, particularly in children with rotavirus-induced diarrhea. Its effectiveness was seen particularly when administered in high doses >10 Billion CFU per day[sup]11[/sup].

Clinical guidelines, including from the World Gastroenterology Organisation (WGO), recommend LGG® for preventing AAD, supported by evidence from multiple meta-analyses and randomised controlled trials[sup]12-15[/sup].

These recommendations highlight LGG®'s effectiveness in reducing the incidence and severity of AAD in both children and adults[sup]12-15[/sup].

Timing: Start LGG® concurrently with antibiotic therapy and continue for 7 days after completing antibiotics[sup]5,8,10[/sup].

Efficacy: LGG® is associated with significant risk reductions in AAD, with numbers needed to treat (NNT) as low as 6 (95% CI 5 to 9) at high doses (>5 Billion CFU daily) in children[sup]15[/sup], and relative risk as low as RR = 0.3 (CI 0.1-0.8) for diarrhoea in adults[sup]9[/sup].

Dosage: The WGO guidelines on probiotics recommend 10 Billion CFU twice daily for antibiotic associated diarrhoea[sup]12[/sup].