Indications for Use and the Core Problem
The primary indication for prescribing microbiological preparations is dysbiosis. This condition can have a completely different etiology; however, in pharmacological practice, special attention is paid to iatrogenic causes.
Most frequently, dysbiosis develops as a direct consequence of antibiotic therapy. The use of broad-spectrum antibiotics inevitably leads to the suppression of normal intestinal microflora, as these drugs destroy both pathogenic and beneficial microorganisms. To correct this condition and return the intestine to a state of eubiosis, targeted drug intervention is required.
Two-Step Strategy for Restoring Eubiosis
Dysbiosis therapy is not limited to simply administering beneficial bacteria. It is a strictly sequential process divided into two interrelated stages: sanitation and reimplantation.
- Stage I — Sanitation. The duration of this period is from 7 to 10 days. Antibiotics serve as the pharmacological agents here. The goal of sanitation is the complete elimination of the pathogen causing dysbiosis, which is localized predominantly in the upper small intestine. The choice of a specific antibacterial drug at this stage is strictly individual and directly depends on the etiology of the identified disorder.
- Stage II — Reimplantation. This is a longer process, taking from 1 to 1.5 months. It is at this stage that microbiological preparations — probiotics — are introduced into the treatment regimen. Their main goal is the systematic colonization of the intestine with normal flora to replace the destroyed pathogenic flora.
Characteristics of Reimplantation Agents
The pharmacological market offers a range of proven microbiological agents. The classic list of preparations for reimplantation includes:
- Dry colibacterin
- Bifidumbacterin
- Bificol
- Lactobacterin
- Bactisubtil
- Biosporin
- Gastropharm
Live cultures serve as the basis for creating these medicinal products: Escherichia coli, bifidobacteria, and various bacilli. The ultimate result of a course of these drugs is the successful colonization of the large intestine with saprophytic (beneficial to humans) bacteria. It is important to note that acidophilic microorganisms predominantly dominate among the engrafting flora.
Dosing Principles and Regimens
Methods for dosing probiotics directly depend on their biological basis. Pharmacology distinguishes two main approaches:
- In weight units. This method is characteristic exclusively of preparations created on the basis of bacilli (a typical example is Bactisubtil).
- In bacteriological doses. This method is used for the vast majority of other microbiological preparations.
The dosing regimen, namely the volume of a single dose, varies depending on the chosen agent. The minimum single dose starts from 2 doses (e.g., when prescribing Gastropharm). The maximum single dose can reach 5–6 doses (this regimen is typical for Bifidumbacterin and Lactobacterin). The standard frequency of oral administration is from 2 to 4 times a day.
Combination Therapy
To achieve the maximum therapeutic effect, probiotics are often used in combination with other substances.
- Combination with prebiotics. The most recommended combination is the simultaneous administration of probiotics with lactulose. The goal of such a combination is to create the most favorable environment in the intestinal lumen that will stimulate the active reproduction of eubiotic microorganisms (normal microflora).
- Combination with antibiotics. In clinical practice, there are situations when stopping baseline therapy is impossible. In such cases, continuing antibiotic therapy directly alongside the administration of probiotics is permitted.