Brand names: Bacid, Bulgaricum IB, DDS-Acidophilus, FLORAjen, Intestinex, ... show all 12 brands Kyo-Dophilus, Lactinex, Probiata, ProBiotic Restore, Superdophilus, Super Vegi-dophilus, Trenev Trio
Drug class: Antidiarrhea Agents
ATC class: G01AX14

Introduction

A bacterium that creates an environment unfavorable to the overgrowth of potentially pathogenic fungi and bacteria; used as an antidiarrheal agent.

Uses for Lactobacillus Acidophilus

Diarrhea

Preparations containing Lactobacillus acidophilus with or without L. bulgaricus are used for treatment of uncomplicated diarrhea, particularly that caused by modification of the intestinal flora by antibiotics.

Lactobacillus preparations may assist in reestablishing the normal physiologic and bacterial flora of the intestinal tract.

Also has been used for treatment of infectious diarrhea, ulcerative colitis, irritable colon, diverticulitis, colostomies with either diarrhea or constipation, functional constipation, mucous or spastic diarrhea, and diarrhea following amebiasis.

Because of a lack of substantial evidence from well-designed, controlled studies to support claims of efficacy, manufacturers can no longer claim usefulness in the treatment of diarrhea. Lactobacillus preparations may remain on the market in the US as foods or food (nutritional) supplements.

Lactobacillus acidophilus, in combination with Bifidobacterium bifidum, may be effective in the prevention of traveler’s diarrhea.

Bacterial Vaginosis

Lactobacillus preparations have been used intravaginally for the treatment of bacterial vaginosis. Results of some studies indicate that intravaginal administration of Lactobacillus acidophilus for 6–12 days or oral administration of Lactobacillus acidophilus for 2 months is more effective than placebo, acetic acid, or no treatment. However, other clinical trials found no substantial difference in cure rate of bacterial vaginosis and in the number of vaginal lactobacilli after intravaginal administration of lactobacilli when compared with placebo and estrogens.

Other Uses

May provide relief to patients with hives, fever blisters, canker sores, and adolescent acne; however, results in these largely self-limiting conditions have been equivocal.

Lactobacillus Acidophilus Dosage and Administration

Administration

Oral Administration

Administer orally, preferably with milk, fruit juice, or water.

Conventional capsules, tablets, and granules may be chewed or swallowed whole.

Granules or contents of Intestinex capsules may be added to or taken with cereal, food, milk, fruit juice, or water.

Enteric-coated capsules should be swallowed whole.

Dosage

Pediatric Patients

Diarrhea

Children <3 years of age

Oral

Some manufacturers recommend that Lactobacillus preparations not be used in infants and children <3 years of age unless under the direction and supervision of a physician.

Children ≥3 years of age

Oral

Lactobacillus acidophilus preparations (containing sodium carboxymethylcellulose): 2 capsules 2–4 times daily.

Lactobacillus acidophilus preparations containing L. bulgaricus: 2 capsules, 4 tablets, or 1 packet of granules 3 or 4 times daily.

Enteric-coated capsules containing Lactobacillus acidophilus and L. casei: 1 capsule daily for the first 2 weeks of therapy; dosage may then be increased up to a maximum of 3 capsules daily if necessary.

When used for self-medication of diarrhea or in the presence of a high fever, do not use Lactobacillus acidophilus preparations for >2 days, unless otherwise directed by a physician.

Adults

Diarrhea

Oral

Lactobacillus acidophilus preparations (containing sodium carboxymethylcellulose): 2 capsules 2–4 times daily.

Lactobacillus acidophilus preparations containing L. bulgaricus: 2 capsules, 4 tablets, or 1 packet of granules 3 or 4 times daily.

Enteric-coated capsules containing Lactobacillus acidophilus and L. casei: 1 capsule daily for the first 2 weeks of therapy; dosage may then be increased up to a maximum of 3 capsules daily if necessary.

When used for self-medication of diarrhea or in the presence of a high fever, do not use Lactobacillus acidophilus preparations for >2 days, unless otherwise directed by a physician.

Cautions for Lactobacillus Acidophilus

Contraindications

• Hypersensitivity to milk or lactose products.

Warnings/Precautions

General Precautions

Intestinal Damage, Infection, or Flatus

Do not use in patients with intestinal damage or infection.

May produce an increase in intestinal flatus at the beginning of therapy; usually subsides with continued therapy.

Weakened Immune System

Do not use in patients with weakened immune system.

Self-medication in Presence of High Fever

Do not use Lactobacillus acidophilus preparations for >2 days, unless otherwise directed by a physician.

Specific Populations

Pregnancy

No adequate and well-controlled studies have been conducted in pregnant women; pregnant women should only use Lactobacillus acidophilus under medical supervision.

Pediatric Use

Some manufacturers recommend that Lactobacillus preparations not be used in infants and children <3 years of age unless under the direction and supervision of a physician.

Common Adverse Effects

Flatulence.

Stability

Storage

Oral

Capsules, Tablets, and Powder

2–8°C.

Actions

• Through the production of lactic acid, creates an environment unfavorable to the overgrowth of potentially pathogenic fungi and bacteria (including putrefactive bacteria) and favors establishment of an aciduric flora.

• Some commercially available preparations containing Lactobacillus acidophilus also contain standardized viable culture of Lactobacillus bulgaricus, which provides transient beneficial flora and enhances the growth of desirable bacteria by forming lactic acid on fermentation of carbohydrates.

Advice to Patients

• Advise patient of possible increased production of intestinal flatus at the beginning of therapy, which usually subsides with continued therapy.

• Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as any concomitant illnesses.

• Importance of women informing their clinician if they are or plan to become pregnant or plan to breast-feed.

• Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

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