International Scientific Association for Probiotics and Prebiotics Addresses Antibiotic Stewardship

The International Scientific Association for Probiotics and Prebiotics (ISAPP) initiated a project this fall to determine if probiotics can reduce antibiotic use. In the context of an individual person, reduced antibiotic use means fewer adverse effects, reduced chance to develop antibiotic resistant pathogens, reduced time to recovery and lower medical cost. In the context of society, reduced antibiotic use means less chance that antibiotic resistant pathogens – which can be difficult to control – will develop and threaten society at large. Governments are recognizing the importance of policy that improves antibiotic stewardship. For example, European Antibiotic Awareness Day supports national campaigns on the prudent use of antibiotics.

During the 2016 ISAPP meeting in Turku, Finland, Drs. Dan Merenstein from Georgetown University and Irene Lenoir-Wijnkoop from University of Utrecht and Danone Research, led a working group to discuss the strength of evidence to support probiotics for common upper respiratory tract infections (URTIs). Probiotics are generally safe and have increasing strength of evidence supporting their role in prevention and reducing duration of common URTIs. Evidence is accumulating but not definitive for the role of probiotics in URTIs.

Available evidence was summarized in a Cochrane meta-analysis (Hao et al. 2015), which included 12 studies evaluating the role of probiotics for URTIs. This review found that probiotic use for 3 to 8 months could result in 11 fewer people out of 100 developing an URTI. This review also found moderate quality evidence that taking probiotics reduces the duration of a URTI by close to 2 days. The financial impact of these effects was considered through economic models for both France and Canada (Lenoir-Wijnkoop et al, 2014; 2016), which concluded that significant cost savings through impact on URTIs would be realized by widespread probiotic use.

It was noteworthy that the Cochrane review also suggested that probiotics could reduce antibiotic prescriptions, at a rate of 7 fewer people in 100. This finding prompted a proposal to conduct a systematic review and meta-analysis designed with a primary endpoint to determine the impact of probiotics on antibiotic use. This project is currently underway, supported in part by ISAPP and also by the volunteer efforts of many experts. The results of the study will be published regardless of the findings. But if robust evidence is found that probiotics can reduce antibiotic use, ISAPP will approach authoritative bodies such as the Center for Disease Control and Prevention, the American Academy of Family Physicians, the American Academy of Pediatrics and the United States Prevention Services task force with the evidence with the hope of influencing adoption of probiotics as part of recommendations and policy on antibiotic stewardship.