PRECISION PROBIOTICS AND ANTIBIOTICS TOGETHER: A CHOICE THAT BENEFITS THE GUT
When a child needs an antibiotic, the approach today no longer focuses solely on fighting the infection. An increasing number of pediatricians also choose to protect the gut, because it is precisely there that antibiotics can cause a significant side effect: disruption of the microbiota balance, which is essential for digestion, immunity, and overall well-being.
This growing attention to intestinal health clearly emerges from a recent national survey* conducted on a large sample of Italian pediatricians. Between July and October 2024, a digital questionnaire consisting of 23 mandatory multiple-choice questions was distributed, with the aim of investigating how and why probiotics are prescribed alongside antibiotic therapy. The survey analyzed frequency of use, clinical indications, strains prescribed, dosages, duration of treatment, and sources of information. A total of 980 pediatricians were involved, and 279 responded, corresponding to 28% of the total.
The most significant result is simple yet telling: 63% of Italian pediatricians state that they always prescribe a probiotic when they prescribe an antibiotic. This is no longer an optional recommendation, but a measure that has become part of established clinical practice.
Why do pediatricians pair a probiotic with an antibiotic?
Survey responses reveal a very clear clinical rationale. Probiotics are prescribed primarily to preserve or restore the balance of the intestinal microbiota (81%) and to reduce the risk of antibiotic-associated diarrhea (47%), a common disturbance that can challenge both the child’s well-being and adherence to treatment.
The goal is to make therapy more tolerable and more effective overall.
The survey highlights wide variability in probiotic choice
Despite the widespread use of probiotics, there is still no uniform consensus on which ones are most appropriate. This leads to considerable diversity in prescribing practices.
In current clinical practice, three main categories of probiotics are used.
The first category includes yeasts, such as Saccharomyces boulardii. These are yeasts belonging to the fungal kingdom, not bacteria. Although they can be useful in limiting certain intestinal manifestations during antibiotic therapy, they are not stable members of the human microbiota: their presence is temporary and does not contribute to rebuilding the intestinal ecosystem.
The second category consists of lactobacilli. These microorganisms belong to a bacterial genus and are often used because their cultivation and industrial production are simpler compared with other microorganisms. However, they are more concentrated in the upper gastrointestinal tract and in other body sites, such as the vaginal microbiota, and are therefore much less representative of the pediatric colon.
Finally, there are bifidobacteria. These also belong to a bacterial genus, but with a feature that clearly distinguishes them from the others. They are among the first natural inhabitants of the infant gut and constitute the most significant component of the colonic microbiota in childhood. They contribute to immune maturation, protection of the intestinal barrier, and overall microbial balance.
This heterogeneity is also clearly reflected in prescribing data: lactobacilli are the most frequently used (95%), followed by yeasts (42%), while bifidobacteria—despite being the microorganisms most representative of the infant gut—are prescribed in only 35% of cases. The percentages are not mutually exclusive, as pediatricians were allowed to indicate more than one category of probiotics they routinely prescribe.
The survey confirms that all three categories are prescribed—although yeasts and lactobacilli remain the most commonly used—while clearly raising the issue of the biological appropriateness of probiotic selection.
When antibiotics act, bifidobacteria are among the first to be affected
One of the most relevant clinical paradoxes concerns bifidobacteria themselves. Although they are the microorganisms most representative of the child’s gut, they are also among the most sensitive to antibiotic therapy.
Antibiotics commonly used in pediatrics, such as amoxicillin and amoxicillin/clavulanic acid, can drastically reduce their presence, promoting dysbiosis and gastrointestinal disturbances.
This leads to a logical question: shouldn’t we be protecting precisely what is most important for maintaining intestinal balance in children?
A new prescribing awareness
The survey results show that this awareness is beginning to emerge. Bifidobacteria are increasingly appearing among pediatricians’ choices. And while the current landscape is still varied, the direction is clear: choosing probiotics that naturally belong to the child’s intestine means supporting antibiotic therapy with a more targeted and effective approach.
It makes sense to support the microorganisms that children host from birth, those that live where antibiotics exert their effects and that are fundamental to intestinal health: bifidobacteria.
Looking ahead: why attention to Bifidobacterium breve PRL2020 is growing
If bifidobacteria represent the most biologically coherent choice for the child’s gut, certain strains are emerging as particularly interesting for clinical practice.
Among these, Bifidobacterium breve PRL2020 has attracted attention for its intestinal specificity and its ability to be used alongside antibiotic therapy.
The literature reports that this strain:
- naturally belongs to the intestinal microbiota
- acts in the colon, where dysbiosis develops
- shows intrinsic resistance (safe and non-transferable) specifically to amoxicillin and amoxicillin/clavulanic acid, antibiotics widely used in pediatrics
It can therefore be taken during these therapies and survive them, continuing to support microbial balance even while the antibiotic is active.
* Biasucci, G.; Capra, M.E.; Giudice, A.; Monopoli, D.; Stanyevic, B.; Rotondo, R.; Mucci, A.; Neglia, C.; Campana, B.; Esposito, S. Use of Probiotics During Antibiotic Therapy in Pediatrics: A Cross-Sectional Survey of Italian Primary Care Pediatricians. Antibiotics 2025, 14, 577. https://doi.org/10.3390/antibiotics14060577