Gueimonde M, Sánchez B. G de Los Reyes-Gavilán C. Margolles A Antibiotic resistance in probiotic bacteria Front Microbiol. 2013;4:202. https://doi.org/10.3389/fmicb.2013.00202. The Chloramphenicol acetyltransferase, that confers resistance against chloramphenicol, is absent in B. amyloliquefaciens and B. coagulans whereas chloramphenicol efflux pump was present in B. amyloliquefaciens (Fig. 4). This would imply the presence of chloramphenicol resistance in all the Bacillus probiotics except B. coagulans. Different classes of beta-lactamase were present in one or the other Bacillus probiotics that clearly suggest the presence of resistance against Penicillin in all the Bacillus probiotics. Multidrug resistance protein, a universal stress protein, EmrB, and its efflux pump, tetracycline resistance protein, and penicillin-binding protein are present in all the Bacillus probiotics. This suggests that most of the Bacillus probiotics are resistant to common antibiotics. Contributes to correct dysvitaminosis- which is the imbalance of production and assimilation of vitamins The dosage for Enterogermina depends on the age and severity of the condition being treated. The recommended dosage for different conditions is: Proton pump inhibitors (PPIs) are commonly prescribed medications [ 1]. They reduce stomach acid production by irreversibly inhibiting the H +/K + ATPase proton pumps [ 2]. Although proven to be well-tolerated, long-term PPI use can cause vitamin B12 deficiency, hypomagnesemia, and Clostridium difficile infections, among other side effects [ 3]. Recent studies have investigated the association between long-term PPI use and small intestinal bacterial overgrowth (SIBO), with some studies indicating a negative influence on health due to PPI-induced dysbiosis [ 4, 5, 6]. Studies have also suggested that short-term (~2 weeks) PPI use does not extend a preventative effect to the small intestine in the case of non-steroidal anti-inflammatory drug (NSAID)-associated small intestine injury; >50% of subjects exhibited such damage following short-course NSAID+PPI use [ 7]. Use of PPIs short-term may exacerbate NSAID-induced intestinal damage in part by inducing significant shifts in enteric microbial populations [ 8]. Furthermore, PPI intake has been associated with an increase in the levels of potentially pathogenic bacteria such as Enterobacteriaceae, Enterococcaceae, and Staphylococcaceae in the small intestine and colon [ 9] and an increased risk of community-acquired enteric infections, especially those caused by Salmonella and Campylobacter spp [ 10].

Mazza P, Zani F, Martelli P. Studies on the antibiotic resistance of Bacillus subtilis strains used in oral bacteriotherapy. Boll Chim Farm. 1992;131:401–8 http://www.ncbi.nlm.nih.gov/pubmed/1299263. Enterogermina is classified by the FDA as a pregnancy category A as it has shown no risk to the growing fetus.

Therapeutic indications

Some of the spore-forming strains of Bacillus probiotics are marketed commercially as they survive harsh gastrointestinal conditions and bestow health benefits to the host. Results The oral suspension adds extra bacteria to your gut and improves the anti-microbial property which promotes faster healing. Susin MF, Baldini RL, Gueiros-Filho F, Gomes SL. GroES/GroEL and DnaK/DnaJ have distinct roles in stress responses and during cell cycle progression in Caulobacter crescentus. J Bacteriol. 2006;188:8044–53. https://doi.org/10.1128/JB.00824-06.

Subtilosin A produced by B. subtilis is also a broad range bacteriocin that is effective against Listeria monocytogenes, and strains of E. faecalis, P. gingivalis, K. rhizophila, Enterobacter aerogenes, Streptococcus pyogenes, and Shigella sonnei [ 53]. Sporulation-killing factor skfA produced by B. subtilis induces the lysis of other B. subtilis cells that have not entered the sporulation pathway. This cannibalistic behavior provides a source of nutrients to support those cells that have entered sporulation [ 59, 60]. At high concentrations, it can also inhibit the growth of other bacteria [ 61]. The presence of well-characterized bacteriocins in the Bacillus probiotics suggests their important role in fighting against the pathogen in the gut. Folate biosynthesis pathways in Bacillus probiotics Patrone V, Molinari P, Morelli L. Microbiological and molecular characterization of commercially available probiotics containing Bacillus clausii from India and Pakistan. Int J Food Microbiol. 2016;237:92–7. https://doi.org/10.1016/j.ijfoodmicro.2016.08.012. Goldstein BP. Resistance to rifampicin: a review. J Antibiot. 2014;67:625–30. https://doi.org/10.1038/ja.2014.107. Gibson MK, Forsberg KJ, Dantas G. Improved annotation of antibiotic resistance determinants reveals microbial resistomes cluster by ecology. ISME J. 2015;9:207–16. https://doi.org/10.1038/ismej.2014.106.

Canani RB, Cirillo P, Terrin G, Cesarano L, Spagnuolo MI, De Vincenzo A, et al. Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations. BMJ. 2007;335:340. https://doi.org/10.1136/bmj.39272.581736.55. Begley M, Cotter PD, Hill C, Ross RP. Identification of a novel two-peptide lantibiotic, lichenicidin, following rational genome mining for LanM proteins. Appl Environ Microbiol. 2009;75:5451–60. https://doi.org/10.1128/AEM.00730-09. Stamatakis A. RAxML version 8: a tool for phylogenetic analysis and post-analysis of large phylogenies. Bioinformatics. 2014;30:1312–3. https://doi.org/10.1093/bioinformatics/btu033.

If you skip a dose of Enterogermina, take it as soon as you realize it. If it is close to the time for your next treatment you can skip it and take your next dose as scheduled then continue with your regular drug schedule. However, do not double the dose to compensate for the skipped dose as it could result in signs of an overdose. Frequent missing doses of your medications makes it less effective in treating your condition. Set the alarm or have a family member remind you when it is time for your next dose. PrecautionsBegley M, Gahan CG, Hill C. The interaction between bacteria and bile. FEMS Microbiol Rev. 2005;29:625–51. https://doi.org/10.1016/j.femsre.2004.09.003. Kanehisa M, Goto S, Kawashima S, Okuno Y, Hattori M. The KEGG resource for deciphering the genome. Nucleic Acids Res. 2004;32:277D–280. https://doi.org/10.1093/nar/gkh063.