Q&A: Preventing Thrush

July 27, 2011. Posted in: BF Concerns: Child,BF Concerns: Mother

By Kelly Bonyata, BS, IBCLC

QUESTION:

I need to take an antibiotic, and I know that this increases my risk of developing thrush. Is there anything I can do to reduce this risk?

ANSWER:

Yes, anytime mom or baby needs to take antibiotics, it may be helpful to use probiotics (acidophus, etc.) as a preventative. There is evidence in the medical literature that probiotics can decrease the risk of candida overgrowth (Drisko 2003, Payne 2003, Kopp-Hoolihan 2001, Lykova 2000). Antibiotics increase the risk of thrush and other yeast infections because they tend to kill off the “good” bacteria along with the bad. These good bacteria are what normally prevent an overgrowth of the yeast (candida) that is always present in our bodies. By taking probiotics, you replace some of the good bacteria in your digestive tract that are needed to prevent a yeast overgrowth.

What are probiotics?

Probiotics are “friendly” or “good” bacteria that are normally present in our bodies and help to prevent the overgrowth of harmful organisms. Examples of probiotics include Lactobacillus acidophilus, Lactobacillus GG, Lactobacillus plantarum, Bifidobacterium longum, Bifidobacterium bifidum, etc. We often hear only about Lactobacillus acidophilus (often simply called acidophilus), which is the most common probiotic, but there are many different probiotic preparations. Bifidobacteria are the predominant bacteria in the intestinal tract of breastfed infants and thus would be a good probiotic choice for an infant or young child.

It may also be helpful to take prebiotics in addition to the probiotics. Prebiotics are soluble fibers that stimulate the growth of probiotics in the gastrointestinal tract. Examples of prebiotics include inulin and fructooligosaccharides (FOS). The term synbiotic is used when probiotics and prebiotics are combined in the same product.

What kind of probiotic should I look for?

  • The most common variety of probiotic is Lactobacillus acidophilus, but there are other formulations available. For baby, consider a variety that contains more Bifidobacteria than Lactobacillus.
  • Dairy-free formulations are available.
  • Many probiotics require refrigeration. Check the label for storage directions.
  • You can also eat yogurt or other dairy products with live acidophilus cultures. Unsweetened is best, since sugar feeds the yeast.

Dosage

Probiotics are generally measured in billions of active cultures rather than milligrams (mg). The number of active cultures varies widely from brand to brand.

Various dosage recommendations range from 10-40+ billion active cultures per day. Daily maintenance dosages commonly range from 2-5 billion active cultures per day.

Most sources suggest that both mom and baby take probiotics. Check your label for baby dosage – it commonly ranges from 1-3 billion active cultures per day.

Many recommend that you start with a lower dosage, and increase it after a week or so.

Some ways to treat baby

  1. Open the capsule, dip your clean finger in the powder and let baby suck it off; or
  2. Mix the powder with a small amount of expressed milk or water; or
  3. Make a paste of the powder with expressed milk or water and swab it in baby’s mouth; or
  4. Add to solid food (for babies over 6 months).

When and how long?

  • Take the probiotics between antibiotic doses (remember that antibiotics can kill these good bacteria). Some recommend waiting two hours after taking the antibiotic.
  • Continue with the probiotics during the time you are taking the antibiotics and for 1-2 weeks after.

Safety

Various probiotics have been used safely in infants (including premature infants), children and adults for many years. Many of these probiotics are found naturally in the GI tract. Some people who take more than 1-2 billion active cultures per day experience mild GI upset (thus the suggestion to start with a lower dosage and increase after a week or so).

Prebiotics: Some people experience GI effects, especially if the dosage is high. There have been reports of anaphylaxis in one person following IV administration of the prebiotic inulin, and in another person who consumed large amounts of inulin from multiple sources. These anaphylactic sensitivities are very rare.

Per SK Dash in Selection criteria for probiotic supplements:

“Lactic acid bacteria have a long history of safe use in dairy products. However, some probiotic supplements now contain bacteria, which have no record of safe use in humans or even animals. There are instances of probiotic supplements containing soil bacteria that are not normal inhabitants of the human gastrointestinal tract. These cultures may potentially be pathogenic. It is imperative to select bacteria for incorporation in probiotic supplements that are on the GRAS (Generally Recognized As Safe) list.

“… L. acidophilus and Bifidobacterium species are normal inhabitants of the human gastrointestinal tract and are GRAS. Probiotic formulations containing these beneficial bacteria along with prebiotic fructooligosaccharides (FOS) are considered safe.”

Additional information

Antibiotics: Can they lead to thrush? by Robert W. Steele, MD

Preventing and treating the side effects of antibiotics from AskDrSears.com

Identifying and Treating Thrush by Cheryl Taylor White, CBE

Acidophilus from AskDrSears.com

Lactobacillus Acidophilus from wikipedia

Probiotics from PeaceHealth

Fructo-oligosaccharides (FOS) and Other Oligosaccharides from PeaceHealth

Probiotics Basics from usprobiotics.org (sponsored by the California Dairy Research Foundation)

Thrush Resources @ kellymom

Useful references

Young RJ, Huffman S. Probiotic use in children. J Pediatr Health Care. 2003 Nov-Dec;17(6):277-83.

Drisko JA, Giles CK, Bischoff BJ. Probiotics in health maintenance and disease prevention. Alternative Medicine Review. 2003 May;8(2):143-155.

Payne S, Gibson G, Wynne A, Hudspith B, Brostoff J, Tuohy K. In vitro studies on colonization resistance of the human gut microbiota to Candida albicans and the effects of tetracycline and Lactobacillus plantarum LPK. Curr Issues Intest Microbiol. 2003 Mar;4(1):1-8.

Dash SK. Selection criteria for probiotic supplements. Townsend Letter for Doctors & Patients. 2003 Feb-Mar.

Elmer GW. Probiotics: “living drugs”. Am J Health Syst Pharm. 2001 Jun 15;58(12):1101-9.

Marteau PR, de Vrese M, Cellier CJ, Schrezenmeir J. Protection from gastrointestinal diseases with the use of probiotics. Am J Clin Nutr. 2001 Feb;73(2 Suppl):430S-436S.

Kopp-Hoolihan L. Prophylactic and therapeutic uses of probiotics: a review. J Am Diet Assoc. 2001 Feb;101(2):229-38; quiz 239-41.

Rolfe RD. The role of probiotic cultures in the control of gastrointestinal health. J Nutr. 2000 Feb;130(2S Suppl):396S-402S.

Lykova EA, et al. Disruption of microbiocenosis of the large intestine and the immune and interferon status in children with bacterial complications of acute viral infections of the respiratory tract and their correction by high doses of bifidumbacterin forte. Antibiot Khimioter. 2000;45(10):22-7.

Vanderhoof JA, Whitney DB, Antonson DL, Hanner TL, Lupo JV, Young RJ. Lactobacillus GG in the prevention of antibiotic-associated diarrhea in children. J Pediatr. 1999 Nov;135(5):564-8.

Journal articles on the use of probiotics in infants

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