Probiotics versus Antibiotics: Is this the only option?


  • Janicke van Wyk School of Science, Engineering & Technology Abertay University Dundee DD1 1HG
  • Randa Haddadin Department of Pharmaceutics and Pharmaceutical Technology University of Jordan Amman
  • Suhair Saleh Department of Pharmaceutics and Pharmaceutical Sciences Applied Sciences University Amman
  • Phillip J Collier School of Science, Engineering & Technology Abertay University Dundee DD1 1HG


probiotics, antibiotics, disease, infection


The role of probiotics in potential prophylaxis of infectious disease has been studied for over a century, but until recently there has been no real interest in using these ‘benign’ bacterial species in place of or in combination with antibiotics. However, such suggestions are now commonplace and lead to a renewed interest in what has until recently been seen as a merely commercial branch of microbiology. This short review looks at the current literature in this area and attempts to identify if there is a scientific basis to inform the cautious clinical use of probiotics either alone or in combination with antibiotics. Whilst the evidence base is to date rather thin, there is sufficient to allow for a cautious support for such ideas. This review also identifies those areas in which further study is required before the general use of probiotics in the treatment of infection may be fully supported.

Author Biographies

Janicke van Wyk, School of Science, Engineering & Technology Abertay University Dundee DD1 1HG

Graduate Student

Randa Haddadin, Department of Pharmaceutics and Pharmaceutical Technology University of Jordan Amman

Assistant Professor

Suhair Saleh, Department of Pharmaceutics and Pharmaceutical Sciences Applied Sciences University Amman


Phillip J Collier, School of Science, Engineering & Technology Abertay University Dundee DD1 1HG

Director of Research Degrees

Senior Lecturer in Microbiology


D’Souza, A.L., Rajkumar, C., Cooke, J. & Bulpitt, C.J. (2002) Probiotics in prevention of antibiotic associated diarrhoea. BMJ, 324, 1361.

Bauer, M.P. & van Dissel, J.T. (2009) Alternative strategies for Clostridium difficile infection. International Journal of Antimicrobial Agents, 33 (S1) S51-S56.

Jones, K. (2010) Probiotics: Preventing antibiotic-associated diarrhoea. JSPN, 15 (2) 160-162.

Isolauri, E., Kirjavainen, P.V. & Salminen, S. (2002) Probiotics: a role in the treatment of intestinal infection and inflammation? Gut, 50 (iii) 54-59.

Gomes da Cruz, A., Buriti, F.C.A., de Souza, C.H.B., Faria, J.A.F. & Saad, S.M.I. (2009) Prrobiotic cheese: Health benefits, technological and stability aspects. Trends in Food science & Technology, 20, 344-354.

Ianitti, T. & Palmieri, B. (2010) Therapeutical use of probiotic formulations in clinical practice. Clinical Nutrition, 29, 701-725.

Venugopalan, V., Shriner, K.A. & Wong-Beringer, A. (2010) Regulatory oversight and safety of probiotic use. Emerging Infectious Diseases, 16 (11) DOI: 10.3201/eid1611.100574.

Lebeer, S., Vanderleyden, J. & Keersmaeker, S.C.J. (2008) Genes and molecules of Lactobacilli supporting probiotic action. Microbiology and Molecular Biology Reviews, 72 (4) 728-764.

Salminen, S., Nyborn, S., Merilouto, J., Collado, C.M., Vesterlund, S. & El-Nezami, H. (2010) Interaction of probiotics and pathogens – Benefits to human health? Current Opinion in Biotechnology, 21, 157-167.

Mack, R.D., Michail, S., Wei, S., McDougall, L. & Hollingsworth, M.A. (1999) Probiotics inhibit enteropathogenic E. coli adherence in vitro by inducing intestinal mucin gene expression. Am J Physiol Gastrointest Liver Physiol. 276, G941-G950.

Begovic, J., Fira, D., terzic-Vidojevic, A. & Topisirovic, L. (2010) Influence of carbohydrates of cell properties of Lactobacillus rhamnosus. Central European Journal of Biology, 5 (1) 103-110.

Korhonen, J.M., van Hoek, A.M., Saarela, M., Huys, G., Tosi, L., mayerhofer, S. & Von Wright, A. (2010) Antimicrobial susceptibility of Lactobacillus rhamnosus. Beneficial Microbes, 1 (1) 75-80.

Tomaro-Duchesneau, C., Saha, S., & Prakash, S. (2014). Modification of the gut microbiota to promote human health. Probiotics, Prebiotics and Gut Health, 15.

Teotia, U. V. S., Kumar, R., Mishra, A. K., & Verma, D. (2014). Role of Probiotics and probiotic beverages on human health. Int. J. Pharm. Med. Res. 2(3):78-84.

Shanahan, F., & Quigley, E. M. (2014). Manipulation of the Microbiota for Treatment of IBS and IBD—Challenges and Controversies. Gastroenterology, 146(6), 1554-1563.

Lorenzo-Zúñiga, V., Llop, E., Suárez, C., Ãlvarez, B., Abreu, L., Espadaler, J., & Serra, J. (2014). I. 31, a new combination of probiotics, improves irritable bowel syndrome-related quality of life. World journal of gastroenterology: WJG, 20(26), 8709.

Wright, K., Wright, H., & Murray, M. (2014). Probiotic treatment for the prevention of antibioticâ€associated diarrhoea in geriatric patients: A multicentre randomised controlled pilot study. Australasian journal on ageing. DOI: 10.1111/ajag.12116.

Wolvers, D., Antonine, J., Myllyluma, E., Schrezenmeir, J., Szajewska, H. & Rijkers, G.T. (2011) Guidance for substantiating the evidence for beneficial effects of probiotics: Prevention and management of infections by probiotics. The Journal of Nutrition, 140, 698S-712S.

Caplan, M.S. & Jilling, T. (2000) Neonatal necrotizing enterocolitis: Possible role of probiotic supplementation. Journal of Paediatric Gastroenterology, 30 (2) S18-S22.

Deltenre, M., Ntounda, R., Jonas, C. & De Koster, E. (1998) Eradication of Helicobacter pylori: Why does it fail? Ital J Gastroenterol Hepatol. 30 (3) S326-S328.

Perri, F., Qasim, A., Marras, L. & O'Morain, C. (2003) Treatment of Helicobacter pylori infection. Helicobacter, 8 (s1) 53–60.

Reid, G. & Bruce, A. (2003) Urogenital infections in women: Can probiotics help? Post-Grad Med J. 79, 428-432.

Zuccotti, G.V., Meneghin, F., Raimondi, C., Dilillo, D., Agostini, C., Riva, E. & Iovanini, M. (2008) Probiotics in clinical practice: An overview. The Journal of International Medical Research, 36 (1) 1A-53A.

Anukam, K.C., Osazuwa, E., Osemene, G.I., Ehigiagbe, F., Bruce, A.W. & Reid, G. (2006) Clinical study comparing probiotic Lactobacillus GR-1 and RC-14 with metronidazole vaginal gel to treat symptomatic bacterial vaginosis. Microbes and Infection, 8 (12–13) 2772–2776.

Shah, N.P. (2007) Functional cultures and health benefits. International Dairy Journal, 17 (11) 1262-1277.

Didari, T., Solki, S., Mozaffari, S., Nikfar, S., & Abdollahi, M. (2014). A systematic review of the safety of probiotics. Expert opinion on drug safety, 13(2), 227-239.

Redman, M. G., Ward, E. J., & Phillips, R. S. (2014). The efficacy and safety of probiotics in people with cancer: a systematic review. Annals of Oncology, mdu106.

Reid, G. (2006) safe and efficacious probiotics: What are they? TRENDS in Microbiology, 14 (8) 348-352.

Pham, L. C., van Spanning, R. J., Röling, W. F., Prosperi, A. C., Terefework, Z., Ten Cate, J. M., ... & Zaura, E. (2009). Effects of probiotic< i> Lactobacillus salivarius W24 on the compositional stability of oral microbial communities. Archives of oral biology, 54(2), 132-137.

Chey, W.D. (2010) Efficacy and safety of probiotics in the treatment of irritable bowel syndrome. US Gastroenterology and Hepatology Review, 6, 48-53.

Snydman, D.R. (2008) The safety of probiotics. Clinical Infectious Diseases, 46 (s2) s104-s111.

Servin, A.L. & Coconnier, M.H. (2003) Adhesion of probiotic strains to the intestinal mucosa and interaction with pathogens. Best Practice and Research Clinical Gastroenterology, 17 (5) 741-754.

Hart, A.L., Kamm, M.J., Stagg, A.J. & Knight, S.C. (2009) Mechanisms of action of probiotics: Recent advances. Inflammatory Bowel Disease, 15 (2) 300-308.