EVALUATION OF KNOWLEDGE AND PERCEPTION AMONG THE PHARMACY STUDENTS ON USE OF PROBIOTICS AS AN ADJUNCT THERAPY WITH ANTIBIOTICS

EVALUATION OF KNOWLEDGE AND PERCEPTION AMONG THE PHARMACY STUDENTS ON USE OF PROBIOTICS AS AN ADJUNCT THERAPY WITH ANTIBIOTICS

Jayalakshmi Venugopal *, Yashwanth Krishna, M. Rajesh Kumar, V. Gowtham, K. Naveen Raj and M. Vignesh

Department of Pharmacy Practice, KMCH College of Pharmacy, approved by PCI & Affiliated to The Tamil Nadu Dr. M. G. R Medical University, Chennai, Tamil Nadu, India.

ABSTRACT: The use of antibiotics to treat infections requires treatment of microbial communities in the gut which causes antibiotic-associated diarrhea (AAD) as a side effect. The number of people using probiotics to manage these effects remains low because there is insufficient awareness of their proper usage. An investigation examines pharmacy student understanding and perceptions about the co-administration of probiotics with antibiotics by studying effectiveness together with timing variables and treatment costs and values. The survey at KMCH College of Pharmacy used structured questionnaire research methodology to evaluate students’ comprehension of probiotic advantages and timing and financial details as well as probiotic-antibiotic interaction awareness throughout the two-month study period. Survey results demonstrated that more than three quarters of participants understood the effects of probiotics against antibiotic side effects, yet respondents exhibited gaps in their understanding about correct strain pick and appropriate timing and storage procedures. Students had varying understandings about how financial matters affected purchasing decisions for probiotics. Research has proven the benefits of probiotics for treatment success, yet a lack of consistent learning demonstrates a necessity to provide enhanced probiotic education. The spread of probiotics encountered resistance because students both misunderstood their benefits and had financial concerns. The data indicates that pharmacy students held favorable beliefs about probiotics even though their information about these products remained deficient. Educational programs about probiotics within pharmacy studies would enhance clinical advice while maximizing antibiotic treatments' effect on both digestive health and treatment success.

Keywords: Probiotics, Antibiotics, Gut Microbiota, Antibiotic-Associated Diarrhea, Pharmacy Education, Microbial Balance

INTRODUCTION: Infection illnesses consistently represent the principal global reason for premature death and disability. Primary medical approaches to manage infections consist of vaccines together with curative therapies though new pandemic threats persist as major obstacles ¹.

Research indicates that probiotics demonstrate promise for medical treatment of human diseases through immune stimulation and pathogenic microorganism inhibition ².

The Food and Agriculture Organization (FAO) together with the World Health Organization (WHO) define probiotics as live microorganisms that demonstrate health benefits in persons when taken through sufficient doses ³. Research findings show that probiotics enhance immunity then inhibit pathogen colonization and minimize infections ⁴. Some protective mechanisms of probiotics remain unclear to science while public education levels about their advantages and proper usage stay low which results in insufficient consumption or misapplied usage ⁵. Providing antibiotic treatments to combat infections ends up destroying beneficial gut microbiota leading to dysbiosis which creates several adverse health outcomes like obesity, asthma, Crohn’s disease and type 1 diabetes ⁶.

Antibiotic-associated diarrhea (AAD) represents the most immediate side effect that results from antibiotic use making microbial balance intervention crucial ⁷. The promising remedy offered by probiotics helps restore healthy intestinal microorganisms while stopping pathogen multiplication and bettering gut health ⁸. One can obtain probiotics through food fermentation such as yogurt and also through supplements in forms including capsules and tablets and powder ⁹.

The human body contains three main probiotic strains including Lactobacillus and Bifidobacterium and Saccharomyces boulardii which restore beneficial bacteria while creating antimicrobial compounds and sustaining gut barriers and controlling immune function ¹⁰. Monitoring research shows that psychobiotics demonstrate mental health advantages through their influence on the gut-brain axis ¹¹.

Scientific research demonstrates how probiotics minimize AAD development and extend to treating both gastrointestinal symptoms and reducing Clostridium difficile infection risk ¹². Food ingredients known as prebiotics work to boost both the functionality of probiotics and enhance gastrointestinal health ¹³.

The modern scientific investigation of probiotics began when Élie Metchnikoff observed in early 20th-century that fermented dairy products produced health benefits ¹⁴. The effects of probiotics become effective by rebalancing gut microbiota while modifying immune responses and blocking pathogenic microbes as well as strengthening gut barrier integrity and producing necessary nutrients particularly short-chain fatty acids (SCFAs) ¹⁵. Numerous studies prove that incorporating probiotics with antibiotics improves therapy results by decreasing antibiotic-caused gut dysbiosis ¹⁶. Two commonly effective probiotic strains for AAD prevention come from Lactobacillus rhamnosus GG and Saccharomyces boulardii which simultaneously fight C. difficile infection risk ¹⁷. A probiotic's effectiveness relates to its particular strain effects and requires optimal time of administration and standardized formulation ¹⁸.

Studies demonstrate that co-administering antibiotic therapies with probiotics leads to improved clinical results together with higher cost-effectiveness through reduced treatment-related problems and accelerated recovery periods as well as reduced dependency on supplemental medications and potential limitations to antibiotic resistance ¹⁹. The availability and reasonable cost of probiotics makes these microorganisms an effective and affordable method to improve antibiotic treatment and general human well-being ²⁰_.

The research evaluates the educational comprehension together with the perceptual understanding of pharmacy student populations about using probiotics along with antibiotics as therapeutic agents. The research examines both student understanding of probioitic-antibiotic coadministration and their evaluation of cost-efficiency related to antibiotic treatment. This research investigates and resolves missing information in pharmacy student understanding about probiotics in antibiotic therapy to provide conclusions on their awareness and attitudes toward antibiotic-probiotic combination therapy.

METHODOLOGY: The research lasted two months within the premises of KMCH College of Pharmacy where pharmacy students received evaluations about combining antibiotics with probiotics. The study utilized a structured questionnaire to investigate vital aspects of probiotic usage such as their advantages as well as timing patterns and financial considerations.

The questionnaire reached Pharmacy students from the institution and these students completed the survey through Google Forms. The data collection process concluded when the researchers analyzed the information to discover student patterns and assessment of probiotics during antibiotic treatment.

OBSERVATIONS AND RESULTS:

TABLE 1: RESPONSES FOR SUPPORTING GUT HEALTH DURING ANTIBIOTIC TREATMENT

Most individuals maintain a positive perception about how fermented foods with fibres can help preserve gut health while receiving antibiotic medication.

TABLE 2: RESPONSES FOR PROBIOTICS ALONGSIDE ANTIBIOTICS TO SUPPORT GUT HEALTH

Most participants endorse the recommendation to combine probiotics with antibiotics for strengthening gut health since few respondents show any opposition to this approach.

TABLE 3: RESPONSES FOR TAKING PROBIOTICS 2 TO 3 HOURS AFTER ANTIBIOTICS FOR BETTER GUT HEALTH

Most participants see taking probiotics 2-3 hours after antibiotics consumption as a beneficial approach to improve gut health while no major disagreements were reported.

TABLE 4: RESPONSES FOR PROBIOTICS RESTORING GUT BALANCE AND REDUCE ANTIBIOTIC SIDE-EFFECTS

A significant portion of respondents agree or strongly agree that probiotics restore gut balance and reduce side effects when combined with antibiotic treatment, with minimal disagreement

TABLE 5: RESPONSES FOR RECOMMENDING TAKING PROBIOTICS FOR ONE WEEK AFTER ANTIBIOTICS

A substantial number of respondents agree or strongly agree that probiotics should be taken for up to one week after antibiotics to support gut health.

TABLE 6: RESPONSES FOR IMPROVING DIGESTION AND REDUCED SIDE-EFFECTS, SHOW PROBIOTICS ARE EFFECTIVE

A notable majority of respondents agree or strongly agree that improved digestion and reduced side effects demonstrate the effectiveness of probiotics, with minimal disagreement.

TABLE 7: RESPONSES FOR REFRIGERATING PROBIOTICS MAINTAIN THEIR EFFECTIVENESS

A clear majority of respondents agree or strongly agree that refrigerating probiotics helps maintain their effectiveness

TABLE 8: RESPONSES FOR PROBIOTICS INCREASE THE COST OF ANTIBIOTIC TREATMENT

Most participants acknowledge that using probiotics adds expense to antibiotic treatment yet display a blend of neutral and opposing views to this assumption.

TABLE 9: RESPONSES FOR THE COST OF PROBIOTICS IS JUSTIFIED BY THEIR THERAPEUTIC EFFICACY

The majority of survey participants believe that probiotics give value for their therapeutic worth a significant majority of respondents agree or strongly agree that completing the full prescribed course of antibiotics helps prevent resistance, with minimal disagreement.

TABLE 10: RESPONSES FOR COMPLETING THE FULL ANTIBIOTIC COURSE PREVENTS RESISTANCE

Graphical Representations of Study Findings: The research sought to determine pharmacy student knowledge and perception levels regarding probiotics as antibiotic adjunct therapy through graphical representation of collected data. Student responses regarding probiotic benefits exceeded 80 and reached 100 at various times in the "Agree" category which demonstrated that most students recognized probiotics as effective tools for gut care and antibiotic side effect management. Responses in the "Neutral" category displayed noticeable changes between 30 to 60 indicating student uncertainty and limited knowledge about uses of probiotics when it comes to strain selection, dosage and timing medicine. The level of agreement surged between 30 and 50 "Strongly Agree" responses at the beginning but it peaked towards the survey conclusion demonstrating that students in these areas positively assessed probiotics. Students who fell under the "Disagree" category produced fewer than 30 responses throughout the study period but showed a slight increase before their numbers tapered off in the middle section of the dataset. This showed that only a minor percentage of students were doubtful about probiotic effectiveness levels. The responses within the "Strongly Disagree" segment remained consistently minimal because very few students expressed potent opposition towards using probiotics as treatment adjuncts. The collected data shows most pharmacy students see the importance of using probiotics with antibiotics but there is still some doubt about their actual practice.

FIG. 1: GRAPHICAL REPRESENTATIONS OF STUDY FINDINGS

DISCUSSION: Probiotics have attracted much interest for the role attributed to them in mitigating side effects associated with antibiotics and improving intestinal health. The articles reviewed give sufficient evidence of the advantages and disadvantages of using probiotics alongside antibiotics. Probiotics are strongly noted to play an effective role in the restoration of gut microbiota balance while alleviating severity related to disruptions associated with antibiotics, as stated by Erni et al. (2024) ²¹. However, parental awareness has been elaborated through Wanj et al. (2024) to impact infant gut health; hence interventions require dietary alterations aimed at preserving microbial homeostasis ²². A good percentage of studies support the use of probiotics during antibiotic treatment. Metanalysis from several studies shows that administration of probiotics with antibiotics diminishes side effects linked with antibiotic administration yet boosts efficacy. Probiotic use is suggested to improve clinical outcomes in pneumonia patients treated with antibiotics, as per Chang H et al (2021) ²³. Probiotics have attracted much interest for the role attributed to them in mitigating side effects associated with antibiotics and improving intestinal health.

Probiotics should be administered 2-3 hours after the completion of antibiotic therapy. According to the work of Thomas H et al. in (2024), the effect that probiotics have on the composition of the microbiota is minimal and ephemeral. This implies that the ideal timing for administration is something that still requires further study. The other emphasizes the need to establish what constitutes the best probiotic treatment, especially with regard to duration following antibiotic therapy. All these studies support probiotics' ability to restore gut balance and reduce side effects ²⁴. The roles of probiotics in improving gut health, reducing gastrointestinal side effects, and regulating immune function have been reported by Sanmith et al. in (2024) and Muhammad et al. in (2021) ^{25, 26}. Probiotics are discussed in immunomodulatory roles restoring gut balance by Mazziotta et al. (2019) ²⁷.

Probiotic stability studies indicate the existence of knowledge gaps among practitioners in the healthcare sector. According to Maram et al. (2024), there are gaps in the knowledge of pharmacists regarding probiotic formulations and that there is a need for additional professional education on the probiotic stability and storage conditions ²⁸. Likewise, Maja D et al. (2024) observed that medical and pharmacy students generally neglected some essential elements of probiotics use, like strain selection and food-drug interactions; thus, these students should be targeted by education. Cost is one of the important factors that follow the usage of probiotics ²⁹. Gordana Z et al. (2023) stated that misconceptions about probiotics roles plus expensive costs become one of the obstacles on it’s widely usage ³⁰. The same issue was tackled by Nicole T et al (2017), who emphasized that probiotics are cost-effective in preventing Clostridium difficile infections, thereby underlining their potential therapeutic value ³¹.

Literature and surveys demonstrate the highest awareness concerning antibiotic stewardship. According to Neha S et al. (2021), most dental practitioners are aware of the inappropriate use of antibiotics and its role in resistance development ³². Correspondingly, Gordana Z et al. (2023) pointed out that educational programs are needed to raise awareness about probiotics and antibiotic resistance ³⁰.

This study of ours probes into the knowledge, attitude, and awareness of pharmacy students regarding probiotics as an adjunct therapy to antibiotics. It was found that although students appreciated the role of probiotics in maintaining gut health and minimizing side effects associated with antibiotics, there were gaps in knowledge particularly in the timing, duration, and strain selection optimal thereof. These findings are in agreement with the current literature evaluating the knowledge of healthcare students and professionals about probiotics.

For instance, Maja D et al. (2024) conducted a cross-sectional study among first- and final-year medical and pharmacy students, which turned out that only 12.5% of students, have good knowledge of probiotics; the largest proportion had fair knowledge, 53.2% ²⁹. Our study found similar results: even though most students knew the benefits of probiotics, they were hesitant in areas like timing and duration of probiotic use. With this uncertainty, both studies point out the need for educational materials within university curricula to better enhance probiotics education among students. In the same vein, Maram et al. (2024) conducted a survey with pharmacists in the UAE reporting gaps in knowledge regarding probiotics' cardiovascular benefits (30%) and alternative dosage forms (16.7%). The other finding of their study was that the misperception about the primary role of probiotics and high cost formed two main barriers toward their utilization ²⁸. Probiotic knowledge was found to be the highest among paediatric gastroenterologists and lowest among paediatric residents in the study conducted by Mohammed H et al. in (2021). Their study also stated that most of the study participants were aware of probiotics' role in alleviating antibiotic-associated diarrhea ³³. Likewise, Yakoob R et al. have discussed these Bifidobacterium species as having increased commercial and clinical significance in probiotic products with functions specified for the reduction of serum cholesterol, lactose intolerance relief, and therapeutic intervention for inflammatory bowel diseases ³⁴. Our research does not target specific probiotic strains but does support their overall conclusion that probiotics are well accepted for gastrointestinal benefits. On the other hand, our research shows that a significant number of students did not know critical information such as strain-specific efficacy and food-drug interactions; thus, there is an urgent need for targeted education about probiotics in pharmacy curricula.

Somayeh S et al. (2018) analyzed probiotic antimicrobial properties and established that beneficial bacteria both stop the growth of pathogens and combine favorably with tetracycline yet demonstrate opposite effects to imipenem and chloramphenicol ³⁵. Research findings show pharmacy students need additional education on strain selection as well as antibiotic-probiotic interactions despite not studying this specific interaction.

The research findings support evidence which shows pharmacy students display favorable attitudes toward probiotics even though they have limited understanding of crucial aspects such as proper timing and length of usage combined with appropriate storage practices. Multiple studies confirm that educational institutions should provide better integration of probiotic subjects because current curriculums fail to deliver sufficient information. Students' perceptions remain influenced by economic problems and by misconceptions about probiotics function alongside inadequate formal learning on the subject. Future pharmacists require evidence-based training to make clinical recommendations about probiotics because they currently lack essential content knowledge.

Comparison between Natural and Synthetic Probiotics: Gut microbiota modulation by natural or synthetic probiotics is a key component of promotion of health and management of disease ³⁶. Most natural probiotics are strains of Lactobacillus and Bifidobacterium, which are widely known for gut health and the ability to reduce inflammation, as is considered in the article ³⁷. Nevertheless, the success of thioredoxin based therapies is greatly reliant on staying intact in gastrointestinal conditions and to integrate in successful in the host microbiome which results in variability in therapeutic outcome ³⁸.

In India, traditional fermented foods serve as rich sources of natural probiotics, including Dahi (Curd) containing Lactobacillus delbrueckiisub sp. bulgaricus and Streptococcus thermophilus, which aid gut health and lactose digestion; Kanji, a fermented rice drink rich in Lactobacillus plantarum, known for its anti-inflammatory properties; Idli and Dosa, fermented rice-lentil batters containing Leuconostoc mesenteroides and Lactobacillus fermentum, which improve digestion and nutrient bioavailability; Gundruk and Sinki, fermented leafy vegetables from Northeast India that support gut microbiota; and Bhaturu, a Himachali fermented wheat product containing Lactobacillus species that contribute to gut and immune health ³⁹. In contrast, more targeted next generation probiotics (NGPs) sophistically engineered or selected to address, for example, inflammatory bowel disease, obesity, metabolic problems, neurodegenerative disease et cetera, offer greater stability, enhanced therapeutic precision, and individualized probiotic treatment that fit a person’s respective microbiome ^{40, 41, 42}.

The advances in synthetic biology now allow for the construction of engineered probiotics that produce bioactive compounds and their modulation of immune response are currently a promising method to use in precision medicine ^{43, 44}. Moreover, natural probiotics face challenges, as they may be strain to strain variable in efficacy, and there are multiple challenges related to NGPs that need to be met before safety and regulatory approval can be assured ⁴⁵. However, the research shows that probiotics have therapeutic potential against antibiotic related side effects, improve digestion and manage systemic diseases, such as cancer and type 2 diabetes. The progression of probiotic research is entailing the transitional shift of general use probiotics to precision engineered microbial therapies, which is a paradigmatic change to personal health in the disease era of personalized medicine. This process is also supported by recent evidence of the gut microbial metabolites' and engineered probiotics' roles in defining a therapeutic outcome and solving complex health problems.

CONCLUSION: The research shows how medical professionals recognize probiotics as powerful medication which supports antibiotic treatments by reducing antibiotic side effects while rebuilding gut microbiota ecosystems. A vast number of pharmacy students recognize the beneficial impact of probiotics regarding intestinal health and immune defense along with their ability to stop antibiotic side effects according to study results. The students lack sufficient knowledge about selecting proper strains and determining appropriate dosages together with proper times for their administration. Future pharmacists will gain the ability to prescribe evidence-based probiotics through intervention programs that fill existing knowledge deficits. The lack of awareness about storage requirements combined with patient perceptions of cost required more education which would support the logical adoption of probiotics in clinical settings. Improved professional skills in addressing probiotics together with better patient education results in positive therapeutic outcomes and enhanced antibiotic usage protection in health services.

ACKNOWLEDGEMENTS: Nil

Fundings: No fundings available

Ethical Approval Statement: Not applicable

Statement of Declaration: Not applicable

CONFLICTS OF INTERST: No conflict of interest.

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    How to cite this article:

    Venugopal J, Krishna Y, Kumar MR, Gowtham V, Raj NK and Vignesh M: Evaluation of knowledge and perception among the pharmacy students on use of probiotics as an adjunct therapy with antibiotics. Int J Pharm Sci & Res 2025; 16(8): 2348-56. doi: 10.13040/IJPSR.0975-8232.16(8).2348-56.

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