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THERAPEUTIC ADHERENCE AND THE MICROBIOTA: WHY SUPPORTING THE GUT HELPS COMPLETE ANTIBIOTIC THERAPIES

When it comes to pharmacological treatments, attention often focuses on choosing the right drug, the correct dosage, and the duration of therapy. Yet there is an element that is as simple as it is decisive for the success of any treatment: therapeutic adherence, that is, the patient’s ability to correctly follow the instructions they receive.

In the case of antibiotics, adherence is even more crucial. Interrupting or modifying treatment can lead to relapses, delay recovery, and—on a broader scale—contribute to the spread of antibiotic resistance. However, antibiotics are also among the drugs that most frequently jeopardize adherence, due to their impact on the intestinal microbiota.

What does “therapeutic adherence” really mean?

Adherence refers to the extent to which a patient follows the physician’s prescriptions: taking the medication at the correct time, not skipping doses, and not stopping the treatment prematurely.

It is a fundamental factor for treatment effectiveness and a true pillar of modern medicine.

But adherence is not only a matter of willpower: it also depends on how well the treatment is tolerated. And this is where the role of the gut comes into play.

Antibiotics and the microbiota: when treatment disrupts balance

Antibiotics are essential for eliminating the bacteria responsible for infections. However, their action is not highly selective: in addition to pathogenic bacteria, they can also affect beneficial microorganisms that help maintain the balance of the intestinal microbiota.

This side effect is known as dysbiosis and may manifest with symptoms such as:

  • diarrhea
  • bloating and abdominal cramps
  • altered bowel habits
  • nausea
  • urogenital disturbances

Dysbiosis is not just a minor inconvenience: it represents a risk factor for early discontinuation of therapy. When a treatment “makes you feel unwell,” completing it becomes much more difficult.

Supporting the microbiota to support therapy: an overview

In children, the balance of the microbiota is particularly delicate. Bifidobacteria—key inhabitants of the infant gut—are essential for immunity, digestion, and the intestinal barrier, but they are also among the most sensitive to the effects of antibiotics. It is therefore not surprising that gastrointestinal disturbances often arise during therapy, making it harder to continue treatment correctly. This is precisely why many pediatricians now prescribe a probiotic alongside antibiotics: a recent national survey shows that 63% do so routinely, with the aim of improving treatment tolerability and supporting microbial balance.

To achieve this benefit, however, the choice of probiotic cannot be generic. It is the strain, not simply the species name, that determines effectiveness. Each strain has unique characteristics—its ability to reach the colon alive, interact with the mucosa, produce beneficial metabolites, and above all to resist (or not) the antibiotic being used. From this perspective, strains with intrinsic resistance represent a particularly targeted and safe form of support, since this resistance is natural, non-transferable, and specific to certain antibiotic molecules.

⭐ A decisive plus for adherence: co-administration without spacing

A frequently underestimated but highly relevant practical aspect concerns how probiotics are taken during antibiotic therapy.

Some probiotics require a gap of several hours from the antibiotic, creating a complex routine that is hard to remember and difficult to maintain—especially in children.

Brevicillin®, on the other hand, can be taken at the same time as the antibiotic, with no need for temporal separation.

This feature has a tangible impact on adherence:

  • it simplifies the daily routine
  • reduces the risk of missed doses
  • avoids adding extra intake times during the day
  • turns supplementation and therapy into a single gesture

Synchronizing probiotic and antibiotic intake makes treatment easier to follow, more intuitive, and more compatible with the real rhythms of family life.

In other words, Brevicillin® not only supports the microbiota, but also supports continuity of supplementation—an essential factor when consistent support is needed throughout the entire course of therapy.

Clinical data confirm this as well: co-administration of PRL2020 significantly reduces gastrointestinal and urogenital disturbances and improves microbiota resilience in the weeks following therapy. The result is a more tolerable treatment that both children and adults are able to follow with greater calm and regularity.

Adherence and public health: an often underestimated link

Improving the tolerability of antibiotic therapy does not benefit only the individual patient.

Correctly completing a course of therapy:

  • reduces the risk of complications
  • prevents recurrences
  • limits additional or inappropriate use of antibiotics
  • helps counter the global emergency of antimicrobial resistance (AMR)

A therapy followed through to the end is more effective, safer, and more responsible.

Conclusions: protecting the gut to protect the therapy

Therapeutic adherence is not just a medical concept—it is the condition that allows a treatment to do its job.

Today we know that preserving microbiota balance during antibiotic therapy is one of the most effective ways to promote better continuity of treatment.

Precision probiotics, selected on the basis of strain and their ability to withstand the antibiotics used, represent a targeted form of support capable of:

  • reducing intestinal disturbances
  • improving treatment tolerability
  • supporting microbiota resilience
  • promoting better therapeutic adherence

And when supplementation can be taken together with therapy, without spacing, the simplicity of the routine itself becomes a therapeutic ally.

Because when a treatment is more tolerable—and easier to follow—it is also easier to complete.
And a treatment that is completed is always a treatment that works better.

* Mancabelli L, Mancino W, Lugli GA, Argentini C, Longhi G, Milani C, Viappiani A, Anzalone R, Bernasconi S, van Sinderen D, Ventura M, Turroni F. Amoxicillin-Clavulanic Acid Resistance in the Genus Bifidobacterium. Appl Environ Microbiol. 2021 Mar 11;87(7):e03137-20. doi: 10.1128/AEM.03137-20. PMID: 33483308; PMCID: PMC8091617.