Probiotics are widely used for prevention and rehabilitation of gastrointestinal disorders. However in recent decades effective probiotics of another concept have appeared - for example, vaginal or oral. This article is intended to teach how to tell pharmacy visitors about them.
According to modern data, probiotics are live microorganisms that, when administered in adequate amounts, have a beneficial effect on human health1,2.
Nowadays probiotics are offered as over-the-counter drugs and dietary supplements. It should be noted that a modern probiotic should include an effective combination of microorganisms with proven probiotic properties - that is, produce biologically active agents to suppress pathogens, be able to colonize to let them become temporary (for treatment period) or permanent inhabitants of the vagina, oral cavity or other microecologies.2,3 To be effective, the drug must also be stable, acid-resistant (when taken orally) and retain viable bacteria during a long shelf life4.
Correcting balanced microflora of the oral cavity is one of the promising areas for probiotics use. Many human diseases can be associated directly (for example, caries, periodontal disease and oral candidiasis) or indirectly (cardiovascular diseases) with occuring imbalance of the oral microbiota2.
Professor Peter van der Bijl (South Africa) states in his review “Relationship between periodontal disease and cardiovascular system”, “Numerous observational (case-control, cohort, cross-sectional), epidemiological and invasive studies support the relation between clinically diagnosed periodontal disease and CAD”. In 2021, an American Heart Association (AHA) task team conducted an electronic literature search on the association between periodontal disease and cardiovascular disease (excluding infective endocarditis), Behçet’s syndrome, Stevens-Johnson’s syndrome, and Sjögren’s syndrome. A total of 537 articles were analyzed in dental/periodontal (61%) and medical (39%) journals. It was concluded that “periodontal disease is related to atherosclerosis, regardless of somatic pathology”, although a direct correlation was not found. Professor van der Bijl suggests that the inflammation associated with periodontal disease may be both a part of pathobiology of atherogenesis and a trigger for plaque rupture.
Oral probiotics are a new generation of probiotic strains evolved from the oral microbiota with extremely low pathogenic potential5. Nowadays, salivarcin-producing probiotics (Streptococcus salivarius M18 and K12) are considered as caries and periodontal diseases prevention, and their potential in bacteriotherapy for dental caries is being researched2,5.
Mechanism of action: producing local antibacterial substances (salivarcins), they normalize oral cavity microbiota without affecting the normal flora adversely5. The M18 strain also produces the enzymes dextranase and urease, which reduce plaque buildup and neutralize oral acidity.
Use: to maintain a healthy balance of oral microflora.
Another probiotic application area is the problem of vaginal infections in women due to their high prevalence, insufficient effectiveness of antimicrobial therapy and the relapse risk. One of the solutions is prescribing modern combined probiotics strains based on lactobacilli obtained from the vaginal biotope of healthy women and protecting the vaginal environment against pathogens6,7,8.
Mechanism of action: protective functions are provided due to lactic and other organic acids, that maintain physiological pH level, production, ability to form a protective biofilm, counteract the adhesion of pathogens, as well as the production of antimicrobial substances (hydrogen peroxide, bacteriocins)8.
Use: to restore the physiological pH level and maintain vaginal microflora balance.
Probiotic lactobacilli can be used both vaginally and orally. It should be noted that when taken orally, probiotics are more effective than vaginal forms, but require a longer intake8.
Today probiotics are considered very promising and require further clinical research. This means that pharmaceutical specialists need to be aware of action and use of modern probiotics in order to provide competent advice to pharmacy visitors.
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