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Background  Antibiotic associated diarrhea and  Clostridium difficile  infection are frequent complications of broad spectrum antibiotic therapy. Probiotic bacteria are used as therapeutic and preventive agents in these disorders, but the exact functional mechanisms and the mode of action are poorly understood. The effects of clindamycin and the probiotic mixture VSL#3 (containing the 8 bacterial strains  Streptococcus thermophilus ,  Bifidobacterium breve ,  Bifidobacterium longum ,  Bifidobacterium infantis ,  Lactobacillus acidophilus ,  Lactobacillus plantarum ,  Lactobacillus paracasei  and  Lactobacillus delbrueckii  subsp.  Bulgaricus ) consecutively or in combination were investigated and compared to controls without therapy using a standardized human fecal microbiota in a computer-controlled  in vitro  model of large intestine. Microbial metabolites (short chain fatty acids, lactate, branched chain fatty acids, and ammonia) and the intestinal microbiota were analyzed.    Results  Compared to controls and combination therapy, short chain fatty acids and lactate, but also ammonia and branched chain fatty acids, were increased under probiotic therapy. The metabolic pattern under combined therapy with antibiotics and probiotics had the most beneficial and consistent effect on intestinal metabolic profiles. The intestinal microbiota showed a decrease in several indigenous bacterial groups under antibiotic therapy, there was no significant recovery of these groups when the antibiotic therapy was followed by administration of probiotics. Simultaneous application of anti- and probiotics had a stabilizing effect on the intestinal microbiota with increased bifidobacteria and lactobacilli.    Conclusions  Administration of VSL#3 parallel with the clindamycin therapy had a beneficial and stabilizing effect on the intestinal metabolic homeostasis by decreasing toxic metabolites and protecting the endogenic microbiota from destruction. Probiotics could be a reasonable strategy in prevention of antibiotic associated disturbances of the intestinal homeostasis and disorders.

Effects of probiotics and antibiotics on the intestinal homeostasis in a computer controlled model of the large intestine