Awareness on how antibiotics slaughter good bacteria in the gut causing loosies in patients is relatively recent and it's only now that some doctors have started prescribing probiotics with antibiotics. But experts say probiotics ought to be prescribed in writing every time a short course of antibiotics is recommended to a patient.
Instructions given orally, like steam inhalation or warm water gargle, are taken as optional, and often skipped, they say. In fact, they recommend that all doctors should write detailed prescriptions, preferably as computer printouts, with not just names of medicines but with proper advisories. Given that the written word is always taken more seriously, the health ministry could consider making this mandatory.

You might be having a course of antibiotics for, say, sore throat or urinary tract infection, but end up with diarrhoea. What is the connection? Put simply, the antibiotics can't make out the good bacteria from the bad, killing them indiscriminately. This leaves the gut vulnerable to infections, resulting in watery bowel movements. Can it be prevented? Yes, simply by having probiotics or good bacteria available as tablets or packaged fermented milk–which guard against antibiotics killing good bacteria.
Antibiotics–induced loosies, medically called antibiotic–associated diarrhoea (AAD) are common among adults, although children are the worst affected, say doctors. Dr Deepika Sur from National Institute of Cholera and Enteric Diseases (NICED) says 5–25% of children on antibiotics suffer from AAD. Dr Sur recently conducted a community–based trial on more than 3,000 children in Kolkata, where the use of a probiotic strain showed a protective efficacy of 14% in preventing acute diarrhoea. Dr Girish Raheja, an ENT surgeon from Apollo Hospital, said: "We have seen that when we prescribe probiotics to patients prone to AAD, they fare better." Dr S K Sarin, professor of gastroenterology at the Insti– of Liver and Sci ences, said doctors should prescribe probiotics in writing, along with antibiotics, just as they write down vitamins.

Dr B S Ramakrishna, gastroenterologist at CMC Vellore agrees: "There is a strong rationale behind prescribing probiotics in writing every time a short course of antibiotics is recommended. There is clear evidence that it preventsani biotic–induced diarrhoea."

At present, prescribing probiotics as an antidote to antibioticsinduced diarrhoea is rare. The following figures bear this out. The probiotics industry in India is estimated to be around Rs 2.06 crore with a projected annual growth rate of 22.6% until 2015. In comparison, the antibiotics market is huge – last year it was over Rs 3,000 crore. Probiotic expert Dr Neerja Hajela says prophylactic use of probiotics can also help. She says even if you are not taking antibiotics, probiotics greatly improve good bacteria in the gut and maintain a proper balance in the body. Her paper says that with more than 1.4 million of the 9 million child deaths being attributed to diarrhoea in 2008, and 49% of them in five countries including India, there is need for intervention to prevent and control diarrhoea diseases. "Of the various interventions, probiotics offer immense potential," she said.

India has now come up with guidelines on the use of probiotics. Experts from the National Institute of Nutrition, who put together the guidelines, said under labelling requirements, a probiotic product must give the genus, species and strain in the product, evidence–based health claims, suggested serving size and proper conditions.