Enterococcus faecium

The literature regarding the role of probiotics in critically ill patients who have undergone mechanical ventilation (MV) is unclear; therefore, this umbrella systematic review and meta-analysis was carried out to clarify the effects of probiotics on the clinical outcomes of mechanically ventilated patients. The Scopus, PubMed/Medline, ISI Web of Science, and Google Scholar online databases were searched up to February 2023. All meta-analyses evaluating the impact of probiotics in patients under MV were considered eligible. The assessment of multiple systematic reviews (AMSTAR) questionnaire was used to evaluate the quality of the studies. Data were pooled using the random-effects approach. Thirty meta-analyses and nine clinical outcomes were re-analyzed. Probiotics significantly decreased ventilator-associated pneumonia (VAP) incidence, nosocomial infections, intensive care unit (ICU) length of stay, hospital length of stay, ICU mortality, hospital mortality, MV duration, duration of antibiotic use, and diarrhea. The obtained results of the current umbrella meta-analysis indicate that probiotic administration could be considered an adjunct therapy for critically ill patients; however, no specific probiotic treatment regimen can be recommended due to the diverse probiotics used in the included meta-analyses. The following microorganisms were used at various doses and combinations throughout the studies: Lacticaseibacillus casei, Lactiplantibacillus plantarum, L. acidophilus, L. delbrueckii, L. bulgaricus, Bifidobacterium longum, B. breve, B. salivarius, Pediococcus pentosaceus, Lactococcus raffinolactis, B. infantis, B. bifidum, Streptococcus thermophilus, Ligilactobacillus salivarius, L. lactis, B. lactis, Saccharomyces boulardii, L. rhamnosus GG, L. johnsonii, L. casei, S. faecalis, Clostridium butyricum, Bacillus mesentericus, L. sporogenes, S. boulardii, L. paracasei, B. subtilis, and Enterococcus faecium.

OBJECTIVE: To compare the outcomes associated with the use of probiotics, prebiotics, and synbiotics for the treatment of chronic constipation in adults. METHODS: We searched eight electronic databases from database inception to July 11, 2023, to identify randomized controlled trials (RCTs) that report efficacy and safety for the treatment of chronic constipation. The risk of bias in the included RCTs was evaluated according to the Cochrane tool, and the certainty of the evidence was assessed using the Confidence in Network Meta-Analysis framework. The analysis was conducted using R version 4.3.0. RESULTS: Out of the 37 RCTs, a total of 21 different types of interventions were reported, involving 3,903 patients. This NMA demonstrated that both prebiotics and synbiotics resulted in an increase in frequency of stool movements per week. Compared to placebo, lactulose (Mean difference [MD] = 3.39, 95% Confdence interval [CI] [1.13, 5.65], moderate certainty), mix2 (consisting of Lactulose and Bacillus coagulans) (MD = 3.63, 95% CI [1.37, 5.89], moderate certainty), mix6 (consisting of Lactulose and Bifidobacterium coagulans) (MD = 4.30, 95% CI [1.04, 7.54], low certainty), and mix7 (consisting of Lactulose, Bifidobacterium subtilis, and Enterococcus faecium) (MD = 4.58, 95% CI [1.35, 7.78], moderate certainty) exhibited a significant effect. Notably, mix7 demonstrated the highest probability of being the most effective intervention (94.8%). Furthermore, when compared to L. plantarum, four probiotics and two synbiotics showed significant advantages in the Patient Assessment of Constipation Symptoms (PAC-SYM) score. L. reuteri (MD = -13.74, 95% CI [-22.20, -4.66], very low certainty) exhibited a significant effect in improving the Patient Assessment of Constipation Quality of Life (PAC-QoL) score. In terms of safety, there were no statistically significant differences between the intervention and control groups in all adverse event analyses. CONCLUSIONS: Moderate to very low evidence supports the use of lactulose and synbiotics to increase the number of weekly stool movements in patients, particularly highlighting the significant impact of synbiotics in increasing the

BACKGROUND: Many randomized controlled trials and systematic reviews have evaluated the use of probiotics to treat acute infectious gastroenteritis. However, most probiotic species evaluated in previous large randomized controlled trials are unavailable in Japan. Our objective was to investigate the efficacy of probiotics utilized in Japan for acute gastroenteritis. METHODS: The inclusion criterion was a randomized controlled study that compared probiotics with a placebo to treat children younger than 18 years with acute infectious gastroenteritis. We excluded studies that did not contain the following species available in Japan: Bifidobacterium spp., Lactobacillus acidophilus, Enterococcus faecium, Clostridium butyricum, and Bacillus subtilis and studies in low- or lower-middle-income countries. We searched PubMed, CENTRAL, and Igaku Chuo Zasshi from their inception to November 27, 2022. After the risk of bias assessment, data on diarrhea duration, number of hospitalizations, length of hospital stay, and adverse effects were extracted. RESULTS: Fourteen studies were included in this meta-analysis. Diarrhea lasting longer than 48 h (7 articles, n = 878) was significantly lower in the probiotic group (risk ratio (RR) 0.70, 95 % confidence interval (CI) 0.59-0.83). The duration of diarrhea (14 articles; n = 1761) was 23.45 h (95 % CI 18.22-26.69) shorter in the probiotic group. Duration of hospitalization (6 articles; n = 971) was 17.73 h (95 % CI 6.9-28.56) shorter in the probiotic group. CONCLUSIONS: Although the certainty of evidence is very low, the use of probiotics for acute gastroenteritis in children may improve diarrhea approximately one day earlier. This study was registered with PROSPERO (CRD 42023405559).

INTRODUCTION: Certain fermented dairy milk products may have beneficial effects on plasma cholesterol levels. However, a number of studies have produced conflicting results as to whether dietary supplementation by a probiotic dairy product containing the bacteria culture Causido(R) reduces plasma cholesterol. OBJECTIVE: To conduct a meta-analysis of intervention studies to evaluate the effect of the Causido(R) culture on plasma total cholesterol and low-density lipoprotein (LDL)-cholesterol. THE PROBIOTIC MILK PRODUCT: The yoghurt product Gaio(R) is fermented with Causido(R), composed of one strain of Enterococcus faecium (human species) with the proposed cholesterol-lowering effect, and two strains of Streptococcus thermophilus. STUDY INCLUSION AND DATA EXTRACTION: Six studies were identified from a literature search and from the yoghurt producer. All studies met the inclusion criteria. Summary data for plasma concentrations of total cholesterol and LDL-cholesterol were extracted from the original publications or by personal request to the authors. Data from 4-8 weeks of treatment duration was used. STATISTICAL ANALYSIS: We performed a traditional meta-analysis where mean differences between intervention and control of the pre-post changes in total cholesterol and LDL-cholesterol were calculated, as well as 95% confidence intervals (CIs). RESULTS: In the six studies included in the meta-analysis, the Gaio(R) interventions produced changes in total cholesterol above those of the control groups ranging from -0.02 to -1.02 mmol/l and in LDL-cholesterol ranging from -0.02 to -1.15 mmol/l. After inclusion of an open-label study, the meta-analysis of the double-blind studies showed that Gaio(R) as compared to the control group changed total cholesterol by -0.22 mmol/l (95% CI: -0.35 to -0.08, P<0.01) and LDL-cholesterol by -0.20 mmol/l (95% CI: -0.33 to -0.06, P<0.005). The outcome was essentially the same if all studies were included. CONCLUSIONS: The present meta-analysis of controlled short-term intervention studies shows that the fermented yoghurt product produced a 4% decrease in total cholesterol and a 5% decrease in LDL-cholesterol when the open-label study is

BACKGROUND AND AIM: Alterations in gut microbiota after colonoscopy have been observed. Moreover, there is limited consensus regarding the impact of the procedure on gut microbiota. We aim to evaluate whether the probiotic can treat gut microbiota and abdominal symptoms disturbance after colonoscopy. METHODS: A total of 301 participants were randomized into probiotic and placebo groups. The probiotic group received live combined Bacillus Subtilis and Enterococcus Faecium-coated capsules (0.5 g thrice daily for 28 days) postcolonoscopy. The placebo group was given placebo in an identical manner. Fecal samples were collected from participants and symptoms were reported. The intestinal microbiota composition was assessed using 16S rRNA sequencing. RESULTS: Notable differences in α (p = 0.011) and β (p < 0.001) diversity were observed after colonoscopy. Bowel cleansing resulted in the proliferation of Pseudomonas and Klebsiella in the placebo group. However, the probiotic group exhibited a marked enrichment in beneficial probiotics such as Lactobacillales (p = 0.002). Gastrointestinal symptom rating scale (GSRS) showed significant improvements in the probiotic group within the initial week (p = 0.005). Patients in the probiotic group who exhibited symptoms experienced fewer days of abdominal discomfort postcolonoscopy (p = 0.034). Additionally, they exhibited enhanced glucose metabolism (p = 0.040) and a notable increase in Lactobacillales (p = 0.009). In the probiotic group, α and β diversities differed significantly in patients without GSRS improvements, and the concentration of Bacteroides was significantly elevated (p = 0.004). CONCLUSION: Gut microbiota was altered after colonoscopy, especially the proliferation of potentially pathogenic bacteria. Administering probiotics postcolonoscopy leads to beneficial alterations in gut microbiota and associated metabolic pathways, while abdominal discomfort symptoms were improved early. © 2025 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

BACKGROUND: Gut dysbiosis and gut-brain-axis involvement in people with Parkinson's disease (PwP) support the use of gut-microbiota-modulating interventions. Probiotics may help manage constipation in PwP; however, mechanisms underpinning additional beneficial properties are unknown. OBJECTIVE: The aim was evaluating the effects of a probiotic (Lacticaseibacillus rhamnosus, Lactobacillus acidophilus, Lactiplantibacillus plantarum and Enterococcus faecium) on gut microbiota, inflammation, motor and non-motor symptoms (NMS) in PwP and constipation. METHODS: In this multicenter, randomized, double-blind, placebo-controlled trial (NCT05146921), PwP and constipation were randomized (1:1) to receive either the probiotic (4.08 × 108 CFU/mL) or placebo orally (70 mL/day) for 12 weeks. The primary endpoint was the differential abundance of gut microbiota taxa between baseline and end-of-treatment in the active versus placebo group. Secondary/exploratory endpoints included changes in inflammatory cytokines plasma levels, short-chain fatty acids (SCFAs) plasma and fecal levels, motor and NMS outcomes after 12 weeks. A per-protocol analysis was performed. RESULTS: Between July 17, 2019 and February 6, 2022, 74 participants were randomized. Data from 35 (probiotic) and 33 (placebo) participants were analyzed. Enrichments of bacteria with beneficial health-related properties (Odoribacteraceae, Enterococcaceae, and Blautia faecicola) were observed in the active group compared to placebo (P ≤ 0.05). Proinflammatory cytokine TNF-α plasma levels decreased with probiotic treatment and increased with placebo (P < 0.05). No changes in SCFAs levels were observed. Reductions in time-to-on and NMS scale scores (P < 0.05) were observed only in the active group. CONCLUSIONS: This probiotic was effective in beneficially enriching the gut microbiota with potential to reduce systemic inflammation, shortening time-to-on following levodopa administration, and alleviating NMS burden in PwP experiencing constipation. © 2025 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. © 2025 The Author(s). Movement Disor

Managing the side effects of diarrhea, which is associated with intestinal microbial dysbiosis, is a crucial challenge in Helicobacter pylori eradication therapy. The aim of this study is to explore whether administration of a probiotic strain Enterococcus faecium 129 BIO 3B-R, a multi-antibiotic resistant lactic acid bacterium, influences the side effects of Helicobacter pylori eradication therapy in adults. Seventy-six adults undergoing this therapy were randomized to receive either Enterococcus faecium 129 BIO 3B-R or a placebo in a double-blind manner. No significant difference was observed in the incidence of diarrhea, the primary endpoint, or in any other secondary endpoints, including intestinal microbiota diversity, between two groups in the overall study population. However, in a post-hoc age-stratified analysis, participants aged 70 and older who used Enterococcus faecium 129 BIO 3B-R experienced tended to have more diarrhea during the eradication period but subsequently experienced significantly less diarrhea after eradication compared to the control group (23.1% vs. 60%). Treatment with Enterococcus faecium 129 BIO 3B-R also maintained higher α-diversity in their intestinal microbiota than those in the placebo group. Those data suggest that the administration of Enterococcus faecium 129 BIO 3B-R could potentially alleviate diarrhea and intestinal dysbiosis in over 70-year-old elderly patients undergoing Helicobacter pylori eradication. © 2025. The Author(s).

Objective: this trial aimed to determine the effects of probiotic supplementation on weight loss and lipid profiles in hypercholesterolemic obese patients. Methods: ın this pilot randomized, double-blind, placebo-controlled trial, hypercholesterolemic obese patients (BMI = 30.0-35.0 kg/m2) were randomly divided into 2 groups to receive either probiotic capsules (n = 12) or a matching placebo (n = 12) groups. The patients in the probiotic group took capsules 2 times a day that contained Enterococcus faecium, Lactobacillus plantarum, Streptococcus thermophiles, Bifidobacterium lactis, Lactobacillus acidophilus, Bifidobacterium longum (1.5 × 109 CFU/g) for 8 weeks. All patients adhered to a medical nutrition therapy that aimed for a weight loss of 0.5 to 1 kg per week. Anthropometric measurements and body composition were taken at baseline and were monitored every week throughout the study. Blood lipids were assessed at baseline and after the 8-week intervention. Results: after the 8-week dietary intervention, both probiotic and placebo groups showed significant decreased in total cholesterol (-36.50 ± 19.27 vs -25.91 ± 19.25, mg/dl), LDL-C (-(31.75 ± 18.11 vs -31.91 ± 31.00 mg/dl) and TG (-31.83 ± 67.37 vs -28.25 ± 59.09), respectively (p < 0.05). Body weight, BMI, body fat ratio, and waist circumference also significantly decreased after the dietary intervention in both groups (p < 0.05). Overall, no significant difference was found neither in the reductions of total cholesterol, LDL-C, TG concentrations nor the anthropometric indices between the probiotic and placebo groups (p > 0.05). Conclusions: the results of our study demonstrated that the administration of probiotic supplements for 8 weeks in obese subjects with hypercholesterolemia had favorable effects on lipid profiles, although there was no beneficial effect compared to the control group. These results indicate that anthropometric indices significantly decreased in response to adherence to the low-calorie diet recommended by dietitians in both the groups. However, conducting more trails with large sample size and longer follow-up time is necessary. Publisher: Objetivo: este ensayo tuvo como objetivo d

BACKGROUND: The novel coronavirus (SARS-CoV-2) led to gastrointestinal manifestations in up to 50% of cases, with diarrhea being common, and probiotics have been suggested as a potential treatment. AIM: This study aimed to assess changes in the microbiome and the effects of a multispecies probiotic in patients with COVID-19 in home quarantine through a fully remote telemedical approach. METHODS: Thirty patients were randomized to receive either the Ecologic AAD probiotic (Winclove Probiotics, Amsterdam, The Netherlands), on the market as OMNi-BiOTiC 10 (Allergosan, Austria), or a placebo for 30 days in a 2:1 ratio. Respiratory and gastrointestinal symptoms were monitored in 2-10-day intervals via online surveys, and five stool samples were collected during the 30-day study period for microbiome and metabolomics analyses. Twenty-four healthy volunteers served as controls. RESULTS: Of the 30 patients, 26 completed this study (10 placebo, 16 probiotic). Patients reported respiratory symptoms and a diminished gastrointestinal quality of life, both of which improved significantly during the study period, irrespective of the intervention. Compared to controls, infected patients showed significant alterations in the fecal microbiome (p = 0.002), including an increase in Bacteroidetes and decreases in Christensenellaceae, Ruminococcaceae, and Gammaproteobacteria, along with metabolomic changes. Probiotic treatment significantly modulated the patients' microbiome beta diversity (p = 0.001) and introduced the Enterococcus faecium W54 strain. Symptoms, COVID-19-related taxa, and the fecal metabolome were not affected by the intervention. CONCLUSIONS: Patients with mild COVID-19 disease in home quarantine exhibited respiratory symptoms, a reduced gastrointestinal quality of life, and changes in the fecal microbiome and metabolome.

BACKGROUND: Sleeve gastrectomy (SG) has become the predominant bariatric surgery, leading to significant weight loss and reductions in obesity-related complications. However, postoperative gastrointestinal symptoms such as constipation and bloating are common. This study aims to evaluate the impact of probiotic supplementation on postoperative gastrointestinal symptoms in patients undergoing SG. The secondary aim is to analyze laboratory and stool test results. MATERIALS AND METHODS: This prospective, placebo-controlled study included patients undergoing SG at a single center. Participants were adults without specific gastrointestinal diseases. They were randomly assigned to either the Probiotics or Controls group. Gastrointestinal symptoms and laboratory and stool tests were assessed before surgery and one month after. RESULTS: Thirty-one patients participated, with 15 in the Probiotics group and 16 in the Controls group. Probiotic supplementation significantly increased the number of stools per week (p = 0.027) and reduced constipation incidence (p = 0.002). Patients in the Probiotics group reported easier defecation and greater bowel movement completeness (p = 0.015, p = 0.004). No significant differences in weight loss or laboratory tests were observed between the groups. Stool microbiota analysis showed a return to normal levels of Enterococcus faecalis, Enterococcus faecium, and Clostridium perfringens in the Probiotics group and an increase in the Controls group. CONCLUSIONS: Probiotic supplementation after SG significantly reduces constipation without adverse effects. These findings suggest that incorporating probiotics into postoperative care protocols can enhance patient comfort and recovery.

BACKGROUND: A novel regimen with high-dose dual therapy (HDDT) has emerged, but its impact on the gut microbiota is not well understood. This study aimed to evaluate the impact of HDDT on the gut microbiota and compare it with that of bismuth quadruple therapy (BQT). METHODS: We enrolled outpatients (18-70 years) diagnosed with Helicobacter pylori infection by either histology or a positive 13C-urea breath test (13C-UBT) and randomly assigned to either the BQT or HDDT group. Subjects consented to provide fecal samples which were collected at baseline, Week 2, and Week 14. Amplification of the V1 and V9 regions of the 16S rRNA was conducted followed by high-throughput sequencing. RESULTS: Ultimately, 78 patients (41 patients in the HDDT group and 37 in the BQT group) were enrolled in this study. Eradication therapy significantly altered the diversity of the gut microbiota. However, the alpha diversity rebounded only in the HDDT group at 12 weeks post-eradication. Immediately following eradication, the predominance of Proteobacteria, replacing commensal Firmicutes and Bacteroidetes, did not recover after 12 weeks. Species-level analysis showed that the relative abundances of Klebsiella pneumoniae and Escherichia fergusonii significantly increased in both groups at Week 2. Enterococcus faecium and Enterococcus faecalis significantly increased in the BQT group, with no significant difference observed in the HDDT group. After 12 weeks of treatment, the relative abundance of more species in the HDDT group returned to baseline levels. CONCLUSION: Eradication of H. pylori can lead to an imbalance in gut microbiota. Compared to BQT, the HDDT is a regimen with milder impact on gut microbiota. © 2024 The Authors. Helicobacter published by John Wiley & Sons Ltd.

OBJECTIVE: To describe the prevalence of potentially clinically relevant gut pathogens and associations with the carriage of resistant organisms in UK care home residents. METHODS: Stool samples were collected pre-randomisation from care home residents participating in a randomised placebo-controlled trial. Cultivable clinically relevant bacteria were analysed. Antimicrobial susceptibility testing was performed by agar dilution (amoxicillin, co-amoxiclav, gentamicin, trimethoprim, nitrofurantoin, and ciprofloxacin). We also aimed to detect resistance to third-generation cephalosporins, carbapenems, and vancomycin. RESULTS: Stool samples were available for 159/310 residents participating in the trial (51%) from 23 care homes between 2016 and 2018. In total, 402 bacterial isolates were cultured from 158 stool samples and 29 different species were cultured. The five most common species were Escherichia coli (155/158, 98%), Pseudomonas aeruginosa (40/158, 25%), Enterococcus faecalis (35/158, 22%), Enterococcus faecium (30/158, 19%), and Proteus mirabilis (25/158, 16%). Enterobacterales isolates were cultured from 157 samples (99%), and resistance to at least one of the tested antimicrobials was found in 119 of these (76%). There were high levels of variation in outcomes by care home. DISCUSSION: We demonstrated that care home residents harbour significant levels of antimicrobial-resistant organisms in their stool. This work emphasises the importance of both enhanced infection control practices and antimicrobial stewardship programmes to support the appropriate use of antimicrobials in this setting.

GOALS: To assess the efficacy and safety of Chinese Medicine Prescription "W-LHIT" in subjects with simple obesity, and to explore its potential mechanism of action. METHODS: Thirty-seven patients aged 18 to 60 from Wei-En hospital (Weifang City, Shandong, China), participated in a double blinded, placebo-controlled study. Subjects were randomly divided into 2 groups, 18 in treatment and 19 in placebo group. The treatment group took the "W-LHIT" capsules for two months, while the control group received placebo capsules. Both groups accepted healthy lifestyle education materials. After a 2-month treatment, the placebo group transferred to open-label treatment after unblinding. RESULTS: 72.22% participants in the treatment group lost more than 5% of their body weight, compared with 36.84% in the placebo group (p < 0.001). Body weight loss and body mass index reduction of the treatment group were also significantly higher than those of the placebo group (p < 0.05). These changes were accompanied by increased abundance of Akkermansia muciniphila and Enterococcus faecium, and decreased abundance of Proteobacteria in gut microbiota. Furthermore, the treatment group also showed improvement in obesity-related comorbidities such as hypertension and elevation of liver enzymes. No serious adverse reactions were found during the study period. Weight did not rebound at a follow-up visit 2 months after treatment. CONCLUSION: W-LHIT significantly improved body weight and comorbid conditions without obvious adverse reaction or rebound weight gain. These effects were associated with increased abundance of probiotics in gut microbiota. W-LHIT may have a potential for treating obesity in conjunction with healthy lifestyle modifications.

BACKGROUND: In the treatment of post-infectious irritable bowel syndrome (PI-IBS), the leading role belongs to the normalization of the composition of the intestinal microbiome, the disturbances of which are associated with previous intestinal infections. AIM: To study the effectiveness of the drug Bifiform in the treatment of PI-IBS. MATERIALS AND METHODS: An open, prospective, comparative, randomized study included 62 patients with PI-IBS. The diagnosis was confirmed by the results of clinical, laboratory and endoscopic examination of the intestine and met the diagnostic criteria for IBS of the Rome Consensus IV. The patients were randomized into 2 groups depending on the therapy. The patients of the main group received an antispasmodic drug (mebeverin 200 mg 2 times a day or trimebutin 200 mg 3 times a day for 4 weeks), an antibiotic (rifaximin 400 mg 3 times a day or nifuroxazide 400 mg 2 once a day for 1 week), a drug that normalizes the consistency of feces (dioctahedral smectite or macrogol 4000) and Bifiform 2 capsules 2 times a day for 2 weeks. For patients of control group similar therapy was performed without the Bifiform. Evaluation of the effectiveness of treatment was carried out at the end of the course of therapy and 6 months after its termination. RESULTS: All included patients with PI-IBS had abdominal pain, flatulence and tenderness to palpation along the bowel, most of them had diarrhea. Disorders of the intestinal microbiota were detected in 77.4% of patients, while excessive bacterial growth in the small intestine occurred in 72.6%, disorders of the colon microbiocenosis with the presence of opportunistic bacteria in 62.9% of patients. A significant part of the patients had a combination of small and large intestinal dysbiosis. Histological examination of the colon mucosa showed signs of low degree of inflammation activity in all patients. The moderate increase in the level of fecal calprotectin was found in 62.2% of patients with colonic dysbiosis. The majority of patients in the main group showed a pronounced positive dynamics of clinical manifestations of the disease, restoration of the normal composition of the intestinal microbiota and

Enterococci are commensal bacteria in humans that are found in the intestine, pharynx and oral cavity and sometimes cause opportunistic infections such as intra-abdominal infections and bacteraemia. Several enterococcal species, especially E. faecium and E. faecalis, have become clinical problems as drug-resistant bacteria, including vancomycin-resistant Enterococci (VRE). Therefore, new antibacterial agents against enterococcal infections are needed. Because several fatty acids (FAs) have been reported to possess antibacterial activity, in this study, the effects of 3 unsaturated fatty acids on enterococci were evaluated using clinically isolated strains. Among the 3 fatty acids we tested, linoleic acid (LA) and palmitoleic acid (POA) exhibited antibacterial activity against E. faecalis and E. faecium. Next, we evaluated the antibacterial activities of the two FAs against 126 enterococcal clinical strains, including five different species. The minimum inhibitory concentration (MIC) of LA varied among bacterial species and strains (ranging from 37.5 to 1200 μM), while the MIC of POA was similar (ranging from 37.5 to 150 μM). Among species, E. faecium strains presented higher MICs than E. faecalis, E. avium and E. casseliflavus strains. In 6 VRE strains, the MICs of LA showed variable (150-1200 μM), whereas MICs of POA were constant at 75 μM. We subsequently investigated the combined effects of LA and POA with several antibiotics and found that LA had synergistic effects with β-lactam, gentamicin, ciprofloxacin and vancomycin against E. faecalis and E. faecium strains, including VRE, whereas POA did not have a significant effect. Our results indicate the potential application of FAs for enterococcal infection. © 2026 The Societies and John Wiley & Sons Australia, Ltd.

Antimicrobial resistance represents one of the most pressing global health challenges of the 21st century, significantly compromising the efficacy of conventional antibiotics. In response to this crisis, the World Health Organization has updated its 2024 list of priority bacterial pathogens-classified into critical-, high-, and medium-risk groups-based on their resistance mechanisms, clinical impact, and global dissemination. This comprehensive review explores the emerging therapeutic potential of antimicrobial peptides (AMPs) when used in synergistic combinations with conventional antibiotics. By dissecting the mechanistic interplay-ranging from membrane disruption and efflux pump inhibition to biofilm penetration and intracellular antibiotic delivery-we provide a structured analysis of how these dual strategies overcome specific resistance barriers. Special emphasis is given to the World Health Organization-designated pathogens such as Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus (methicillin-resistant/vancomycin-resistant), Enterococcus faecium, Salmonella spp., Shigella spp., and Mycobacterium tuberculosis. Supported by extensive in vitro and in vivo data, this review catalogs dozens of successful AMP-antibiotic pairings, highlighting their fractional inhibitory concentration indices, clinical relevance, and implications for translational development. The evidence presented demonstrates that AMPs not only potentiate antibiotic action but also extend the useful lifespan of existing drugs while reducing toxicity. These findings support the advancement of AMP-based combination therapies as a next-generation strategy to contain resistance and restore the effectiveness of the antimicrobial arsenal. SIGNIFICANCE STATEMENT: Antimicrobial resistance remains a global health emergency, especially among World Health Organization 2024 priority pathogens. This review highlights the therapeutic promise of synergistic combinations between antimicrobial peptides and conventional antibiotics, offering a rational strategy to restore efficacy, overcome resistance mechanisms, and extend the clinical utility of e

PURPOSE: Current treatment options for infections caused by vancomycin-resistant (VR) Enterococcus faecium remain limited and often suboptimal. This study investigates the in vitro activity of combination therapies involving fosfomycin and oxazolidinones (linezolid, contezolid, delpazolid, and sutezolid) against five vanA and five vanB E. faecium isolates obtained from blood cultures. METHODS: The synergistic activity of fosfomycin combined with each oxazolidinone was assessed using checkerboard and time-kill assays. RESULTS: Synergistic interactions were demonstrated with all fosfomycin-oxazolidinone combinations, although the effect was more consistent with delpazolid. In some cases (one for contezolid, three for linezolid, four for sutezolid), the interaction was additive rather than synergistic. Synergy was mainly driven by a significant reduction in fosfomycin minimum inhibitory concentration (MIC), up to 16-fold, while decreases in oxazolidinone MIC were modest. Time-kill assays performed on representative isolates Ef-3 (vanB) and Ef-10 (vanA) confirmed the synergistic interactions, showing a reduction in viable cell counts after 24 h. CONCLUSION: Our findings provide preclinical evidence supporting the use of fosfomycin in combination with novel oxazolidinones as a promising therapeutic strategy against VR E. faecium infections. © 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Antibiotic-resistant bacteria, particularly the ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) pathogens, pose a major public health threat. Their ability to reside inside cells contributes to their persistence and resistance. Combining rifampicin with polymyxins is a much-discussed approach against multidrug-resistant Gram-negative bacterial infections. We therefore evaluated a combination of polymyxin B and rifampicin against Gram-negative clinical isolates in extracellular and intracellular in vitro models of infection. The combination was synergistic against intra- and extra-cellular forms of P. aeruginosa, A. baumannii, E. coli, and K. pneumoniae. This synergy was enhanced in an acidic environment resembling the host vacuole where intracellular bacteria reside. The combination remained synergistic against rifampicin and polymyxin B-resistant P. aeruginosa. To reveal the molecular underpinnings of the synergy, we used reverse genetics to identify and describe P. aeruginosa mutants more susceptible to the combination. They show altered membrane properties and more pronounced oxidative damage when exposed to the combination. This work sheds a new light on the mechanisms of the synergy between rifampicin and polymyxins, demonstrates its applicability to Gram-negative ESKAPE pathogens, including when residing intracellularly. Overall, the data suggest that repurposing rifampicin with polymyxin B can effectively target hard-to-eradicate intracellular bacteria.

BACKGROUND: Infective endocarditis (IE) is a severe infection requiring efficient, sometimes combined, antibiotic therapy. For β-lactam-susceptible Enteroccus spp., particularly Enterococcus faecalis (EFS), the combination of amoxicillin and ceftriaxone is currently recommended. However, limited data are available for ampicillin-susceptible E. faecium strains (EFM-S). OBJECTIVES: To characterize the in vitro synergy of amoxicillin/ceftriaxone combination against clinical isolates of EFM-S and evaluate its clinical relevance. METHODS: Twenty-six EFM-S and 10 EFS clinical isolates from the Henri Mondor Hospital (Créteil, France) were tested. EFM-S clades were previously determined by whole-genome sequencing. Checkerboard assays were performed to assess the MICs and synergy across a range of amoxicillin and ceftriaxone concentrations. The fractional inhibitory concentration (FIC) index was computed for each combination, with synergy defined as ΣFIC ≤ 0.5. RESULTS: Amoxicillin and ceftriaxone MIC distributions were comparable between EFM-S (amoxicillin, 0.06-2 mg/L; ceftriaxone, 1 to ≥1024 mg/L) and EFS (amoxicillin, 0.5-2 mg/L; ceftriaxone, 64 to ≥1024 mg/L). Synergy was observed in 21/26 EFM-S and all EFS strains. The five non-synergistic EFM-S strains had low ceftriaxone MICs (1-16 mg/L), probably limiting synergy detection. No difference was observed according to EFM clades. The minimal synergistic concentrations were consistently higher for EFM-S (median amoxicillin, 0.125 mg/L; ceftriaxone, 32 mg/L) compared to EFS (amoxicillin, 0.03 mg/L; ceftriaxone, 2 mg/L). CONCLUSIONS: Despite in vitro synergy, the amoxicillin/ceftriaxone combination is clinically irrelevant for EFM-S IE due to unachievable drug concentrations in vivo. These findings support clearer guidelines explicitly excluding this regimen for E. faecium, regardless of β-lactam susceptibility. © The Author(s) 2025. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink servi

The emergence of antibiotic resistance continues to pose a significant global challenge. Drug repurposing, wherein existing therapeutics are evaluated for new applications, offers a promising strategy to address this issue. Farnesyltransferase inhibitors (FTIs), initially developed for cancer therapy, have demonstrated antimicrobial activity against several gram-positive bacteria. This study investigates their activity in combination with colistin against gram-positive and gram-negative bacteria. We focus on key ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pathogens while incorporating additional bacterial strains to provide a comprehensive understanding of differential responses and potential dose-dependent synergistic effects. Antimicrobial susceptibility was assessed using broth microdilution, while synergy was evaluated through checkerboard, time-kill, and growth kinetics assays. When combined with sub-inhibitory colistin, FTIs inhibited gram-negative bacterial growth. Tipifarnib exhibited more potent antimicrobial activity against gram-negative strains than lonafarnib. Peptidomimetic FTIs, B581 and FTI-277, inhibited gram-negative bacteria in combination with colistin but had no effect on the gram-positive strains tested. In contrast, alpha-hydroxy farnesyl phosphonic acid, an FPP analog, and bempedoic acid, targeting the mevalonate pathway, showed no antibacterial activity. In addition to their known inhibition of gram-positive bacteria, FTIs exhibited efficacy against gram-negative bacteria, including colistin-resistant Enterobacter cloacae subsp. cloacae, when combined with sub-inhibitory colistin. This might be due to a mechanism distinct from their eukaryotic targets, potentially involving the disruption of multiple biosynthetic pathways. Future studies will focus on elucidating these mechanisms of FTIs and exploring the therapeutic potential of FTI/colistin combinations against ESKAPE and other multidrug-resistant pathogens. Copyright: © 2025 Klose et al. This is an open access article distributed under the terms of the Creative Commons Attributi

Erratum in Front Cell Infect Microbiol. 2026 Jun 08;15:1750002. doi: 10.3389/fcimb.2025.1750002. BACKGROUND AND AIM: The global rise in antimicrobial resistance (AMR) has rendered many conventional antibiotics less effective, particularly against nosocomial pathogens such as Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Proteus mirabilis. This study investigated the antimicrobial and synergistic effects of postbiotics derived from Lacticaseibacillus casei, Lactobacillus bulgaricus, Enterococcus faecium, and Streptococcus thermophilus, administered alone or in combination with either linezolid (for S. aureus) or amikacin (for Gram-negative strains). MATERIALS AND METHODS: Postbiotics were obtained through anaerobic fermentation, followed by centrifugation and filtration. Cytotoxicity was assessed via MTT assays on Vero cell lines. Infection models involving pathogen-specific adhesion and invasion assays were used, with CFU/mL quantification and statistical evaluation by one-way ANOVA and Tukey's post hoc test. RESULTS: The postbiotics exhibited potent antimicrobial activity across all tested pathogens. Combined with linezolid, the dual and triple postbiotic formulations significantly enhanced antibacterial effects against S. aureus from the early hours of incubation. Similarly, combinations with amikacin produced potent synergistic effects against E. coli, P. aeruginosa, and P. mirabilis, particularly in triple combinations involving L. casei and L. bulgaricus. Postbiotics sometimes outperformed antibiotics, such as ST+LC postbiotics against P. mirabilis. These findings suggest that postbiotics can enhance antibiotic efficacy-possibly by modulating membrane permeability, disrupting biofilms, or altering bacterial communication systems. Their low cytotoxicity and pathogen-specific responses indicate that postbiotics are safe and may be tailored for targeted use. CONCLUSIONS: In conclusion, postbiotic-antibiotic combinations, especially with linezolid and amikacin, present promising low-toxicity, synergistic therapeutic strategies. These results lay a strong foundation for advancing microbiome-based adjunct therapies to combat AMR in clinica

OBJECTIVES: Enterococcus faecium, a significant hospital associated pathogen, poses substantial treatment challenges. While combinations of ampicillin with cephalosporins are first-line therapies to treat Enterococcus faecalis high-mortality-rates infections, their efficacy against ampicillin-susceptible E. faecium (ASEfm) is less clear. This study evaluates the effectiveness of combining ampicillin with ceftriaxone or ceftaroline against ASEfm strains. METHODS: Ten ASEfm bloodstream isolates from complicated infections were analyzed. Susceptibility to several antibiotics, including ceftriaxone, ceftaroline, and cefotaxime, was determined using standard methods. Time-kill assays were conducted to assess the synergistic and additive effects of ampicillin in combination with ceftriaxone or ceftaroline. RESULTS: Time-kill studies revealed that ampicillin combined with ceftaroline demonstrated synergistic and/or additive effects in 7 out of 10 strains analyzed. In contrast, ampicillin combined with ceftriaxone showed less pronounced synergy, with only 3 out of 10 strains exhibiting synergistic and/or additive effects. CONCLUSIONS: Our findings indicate that ampicillin combined with ceftaroline, or ceftriaxone provides synergistic activity against some but not all ASEfm clinical isolates. The observed synergy suggests that these combinations could offer a potential therapeutic option for challenging ASEfm infections. © The Author(s) 2025. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.

AIMS: Enterococcus faecium is one of the most important opportunistic pathogens threatening human health worldwide. Resistance to vancomycin (VAN) is increasing at an alarming rate. Resurrecting antibiotics using a combination approach is a promising alternative avenue. Galangin (GAL) is a bioactive compound constituted in herbal plants. This study aimed to evaluate the synergistic activity of the combination of GAL and VAN and mode of action against vancomycin-resistant E. faecium (VREfm) strains. METHODS AND RESULTS: The minimal inhibitory concentrations against these bacteria were 8-64 μg ml-1 for VAN and 512 μg ml-1 for GAL. The VAN plus GAL combination exhibited synergistic effects against E. faecium isolates, with a fraction inhibitory concentration index of 0.26-0.28. Time-kill assays confirmed this synergism. Mechanistic studies showed that the combination induced intracellular constituent leakage, suggesting impaired membrane permeability and electron microscopy revealed peptidoglycan and membrane damage. Additionally, the GAL plus VAN combination inhibited biofilm formation and significantly reduced lipid, protein, and carbohydrate contents, as shown by Fourier-transform infrared spectroscopy (FTIR). CONCLUSIONS: GAL could reverse the activity of VAN against VREfm by damaging bacterial cell envelope, inhibiting biofilm formation, and reducing biomolecule contents, emphasizing its potential as a valuable adjunct to VAN in treating VREfm infections. © The Author(s) 2025. Published by Oxford University Press on behalf of Applied Microbiology International.

The emission of glyphosate and antibiotic residues from human activities threatens the diversity and functioning of the microbial community. This study examines the impact of a glyphosate-based herbicide (GBH) and common antibiotics on Gram-negative bacteria within the ESKAPEE group (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp. and Escherichia coli). Ten strains, including type and multidrug-resistant strains for each species were analysed and eight antibiotics (cefotaxime, meropenem, aztreonam, ciprofloxacin, gentamicin, tigecycline, sulfamethoxazole-trimethoprim, and colistin) were combined with the GBH. While most combinations yielded additive or indifferent effects in 70 associations, antagonistic effects were observed with ciprofloxacin and gentamicin in five strains. GBH notably decreased the minimum inhibitory concentration of colistin in eight strains and displayed synergistic activity with meropenem against metallo-β-lactamase (MBL)-producing strains. Investigation into the effect of GBH properties on outer membrane permeability involved exposing strains to a combination of this GBH and vancomycin. Results indicated that GBH rendered strains sensitive to vancomycin, which is typically ineffective against Gram-negative bacteria. Furthermore, we examined the impact of GBH in combination with three carbapenem agents on 14 strains exhibiting varying carbapenem-resistance mechanisms to assess its effect on carbapenemase activity. The GBH efficiently inhibited MBL activity, demonstrating similar effects to EDTA (ethylenediaminetetraacetic acid). Chelating effect of GBH may have multifaceted impacts on bacterial cells, potentially by increasing outer membrane permeability and inactivating metalloenzyme activity. © 2024. The Author(s).

BACKGROUND/AIMS: The effects of probiotic supplementation on Helicobacter pylori (H. pylori) eradication therapy are not completely understood. In this study, we investigated the effects of continuous probiotic administration on eradication rates, recrudescence, and symptom response following completion of a course of H. pylori therapy. METHODS: This prospective, randomized, double-blind placebo-controlled trial was performed between June 2018 and 2020. Twohundred seventy patients who received a standard triple regimen for H. pylori eradication, were included in the study. Participants were randomized to receive a probiotic as adjunctive therapy (Enterococcus faecium 4.5×108 and Bacillus subtilis 5.0×107; Medilac-S®, Hanmi Pharmaceuticals, Seoul, Korea) or a placebo (one tablet thrice daily) for 28 days, following H. pylori eradication. Participants who showed successful eradication underwent a repeat 13C-urea breath test after 6 months. RESULTS: Eradication rates in the probiotic and placebo groups were 77.1% and 72.4%, respectively (P=0.48) using per-protocol analysis. Using intention-to-treat analysis, eradication rates were 67.4% and 65.9%, respectively (P=0.43). Of 149 patients who were followed-up after 6 months, four patients had recrudescence (2.7%). Recrudescence rates did not differ between the probiotic and placebo groups. Of the 76 patients who had non-ulcer dyspepsia, 60 (78.9%) showed symptom resolution after 6 months. This beneficial effect was most pronounced in patients with postprandial distress syndrome (P=0.02). CONCLUSIONS: Consecutive probiotic supplementation following H. pylori eradication therapy did not increase eradication rates or decrease recrudescence rates.

Erratum in J Neurogastroenterol Motil. 2023 Jan 30;29(1):125. doi: 10.5056/jnm21202E. BACKGROUND/AIMS: We aim to evaluate the differences in the microbiome of responders and non-responders, as well as predict the response to probiotic therapy, based on fecal microbiome data in patients with diarrhea-predominant irritable bowel syndrome (IBS-D). METHODS: A multi-strain probiotics that contains Lactobacillus acidophilus (KCTC 11906BP), Lactobacillus plantarum (KCTC11867BP), Lactobacillus rhamnosus (KCTC 11868BP), Bifidobacterium breve (KCTC 11858BP), Bifidobacterium lactis (KCTC 11903BP), Bifidobacterium longum (KCTC 11860BP), and Streptococcus thermophilus (KCTC 11870BP) were used. Patients were categorized into probiotic and placebo groups, and fecal samples were collected from all patients before and at the end of 8 weeks of treatment. The probiotic group was further divided into responders and non-responders. Responders were defined as patients who experienced adequate relief of overall irritable bowel syndrome symptoms after probiotic therapy. Fecal microbiota were investigated using Illumina MiSeq and analyzed using the EzBioCloud 16S database and microbiome pipeline (https://www.EZbiocloud.net). RESULTS: There was no significant difference in the alpha and beta diversity between the responder and non-responder groups. The abundances of the phylum Proteobacteria and genus Bacteroides significantly decreased after probiotic treatment. Bifidobacterium bifidum, Pediococcus acidilactici, and Enterococcus faecium showed a significantly higher abundance in the probiotic group after treatment compared to the placebo group. Enterococcus faecalis and Lactococcus lactis were identified as biomarkers of non-response to probiotics. The abundance of Fusicatenibacter saccharivorans significantly increased in the responders after treatment. CONCLUSIONS: Probiotic treatment changes some composition of fecal bacteria in patients with IBS-D. E. faecalis and L. lactis may be prediction biomarkers for non-response to probiotics. Increased abundance of F. sccharivorans is correlated to symptom improvement by probiotics in patients with IBS-D.

The present study was conducted to select appropriate microbial strains for the development of fermented Alisma canaliculatum A. Br. et Bouche (FAC) feed additive and to examine their effects on broilers. In experiment 1, 16 strains of Lactobacillus acidophilus, Lactobacillus plantarum, Enterococcus faecium, Bacillus subtilis, Bacillus coagulans, and Saccharomyces cerevisiae from the Korean Collection for Type Cultures (KCTC) were evaluated. The strains were tested for their acid, bile, and heat tolerance levels. Among them, L. acidophilus KCTC 3111, E. faecium KCTC 2022, B. subtilis KCTC 3239, and S. cerevisiae KCTC 7928 were selected to produce FAC. For experiment 2, 140 Ross broiler chicks were allocated to four 5-wk-long dietary groups: NC (basal diet), PC (basal diet with 0.005% oxytetracycline), AC (basal diet with 0.5% A. canaliculatum rhizome powder), and FAC (basal diet with 0.5% FAC). Final BW and total BW gain were increased (P < 0.05) upon the addition of FAC, whereas feed conversion ratio improved (P < 0.05) in the supplemented groups compared with the NC group. Crude protein content increased and crude fat decreased (P < 0.05) in the breast meat of the FAC group compared with the AC and PC groups, respectively. Proventriculus and kidney relative weights of the FAC group differed (P < 0.05) from the AC group but not from the PC group. Lower (P < 0.05) thiobarbituric acid reactive substances value of thigh meat was observed in the FAC group compared with the other groups. The FAC diet increased (P < 0.05) α-linolenic acid and linoleic acid in meat. Alteration of these fatty acids led to increased levels of polyunsaturated fatty acid, polyunsaturated fatty acid /saturated fatty acid, n-3 and n-6 fatty acids, and decreased n-6/n-3 ratio in breast or thigh meat (P < 0.05). It is concluded that FAC confers high tolerance to acid, bile and heat; and beneficially affects growth, meat composition, oxidative stability, and fatty acid composition. The FAC may be a functional feed additive in broilers.

Enterococcus faecium IS-27526 is a novel probiotic isolated from dadih, an Indonesian traditional fermented buffalo milk. A 90 days randomized double-blind placebo-controlled study of pre-post trial was conducted in pre-school children with two groups, placebo and probiotic group. Ultra High Temperature low fat milk was used as a carrier in each group. The aims of this study were to investigate the effect of E. faecium IS-27526 in milk on humoral immune response and on bodyweight of pre-school children. Total serum IgA and total salivary sIgA were measured by sandwich ELISA. The bodyweight of young children was measured. The results showed that total serum IgA did not significantly increase in the probiotic group compared with the placebo group. Total salivary sIgA level and the bodyweight significantly increased (p < 0.05) in probiotic groups compared to the placebo. Changes of total salivary sIgA level were significantly higher in underweight children supplemented with probiotic. Weight gain was observed significantly in children with normal bodyweight supplemented with probiotic. Neither mortality nor weight loss was recorded throughout the study. Taken together, novel probiotic E. faecium IS-27526 has significant positive effects on humoral immune response, salivary sIgA, in underweight pre-school children, and on weight gain of pre-school children.

Probiotics as dietary supplements have been readily accepted by Asian populations. Use of certain probiotic preparations is widespread and the number of clinical trials undertaken with such products is unparalleled in western scientific literature. One such preparation, containing a combination of Enterococcus faecium R0026 and Bacillus subtilis R0179, has 23 publications on post-market clinical studies involving over 1,800 adults. The majority of these publications are printed in Chinese and Korean journals. This review examines the clinical findings with this probiotic combination. As mono-therapy, it has been used to overcome symptoms associated with chronic diarrhoea and irritable bowel syndrome. It has been used as co-adjuvant therapy with sulfasalazine and mesalazine to improve remission times in mild to moderate Ulcerative Colitis and to improve compliance with conventional triple therapy for Helicobacter pylori eradication. While the much of the data is preliminary and the study designs require refinement, the contribution of these trials should not be ignored. The information derived in this review will provide practitioners with practical information on appropriate applications for probiotic supplements, expected outcomes, dosing regimes, safety and reported adverse events. Furthermore, identification of problems in these trials should help researchers design better clinical trials when investigating probiotic products.

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) tract disorder that has heterogeneous clinical presentations such as abdominal pain, diarrhea, constipation, and abdominal distension. It is known that several mechanisms are involved in the pathogenesis of IBS. Probiotics may target one or more pathophysiologic pathways in IBS and may improve the symptoms of IBS. However, the results of studies about probiotics on IBS are controversial. Therefore, the aim of this study was to evaluate the effect of probiotics on GI symptoms and intestinal gas volume changes in patients with IBS. METHODS: Forty patients were randomly allocated to be treated with Medilac DS (Bacillus subtilis, Streptococcus faecium) (n=20) or placebo (n=20) in a double-blind, prospective manner. The change in intestinal gas volume and symptom scores after 4-week treatment were evaluated for the efficacy. RESULTS: There was no significant difference in bloating, frequency of gas expulsion, frequency of defecation, and hardness of stool before and after the treatment. However, the severity of abdominal pain and the frequency of abdominal pain decreased significantly in Medilac DS group (2.4+/-1.3 cm/day --> 1.6+/-1.6 cm/day, 1.7+/-1.3/day --> 1.0+/-1.0/day) (p=0.044, p=0.038), but not in placebo group (2.1+/-2.0 cm/day --> 1.8+/-2.1 cm/day, 1.3+/-1.2/day --> 1.4+/-1.9/day). In both groups, intestinal gas volume at baseline, after 2-week treatment, and after 4-week treatment did not show significant change. Medilac DS was well tolerated without adverse events. CONCLUSIONS: Medilac DS is a safe and useful probiotic agent for the treatment of abdominal pain in patients with IBS.