Three investigations were conducted to assess the effects of selected bio-active feed additives on tilapia (Oreochromis niloticus) growth performance, feed utilisation, haemato-immunological status, intestinal morphology and microbiology. The first experiment was conducted to evaluate the effects of feeding tilapia semi-practical diets supplemented with exogenous enzymes (phytase, protease or carbohydrase). After six weeks of the dietary supplementation, tilapia fed diets supplemented with exogenous enzymes (phytase and carbohydrase) showed enhanced growth performance and higher microvilli density when compared to the control group. Additionally, the intestinal bacterial community profile of tilapia fed the carbohydrase supplemented diet was significantly altered in contrast to those fed the control diet. In the second experiment, tilapia were fed with practical diets supplemented with exogenous enzymes (phytase, protease or xylanase) for eight weeks. Tilapia fed the xylanase supplemented diet demonstrated significantly higher final body weight (FBW), improved feed conversion ratio (FCR) and better protein efficiency ratio (PER) when compared to the control group. Apparent digestibility coefficients of protein, ash, energy, phosphorus, calcium and sodium were highest in tilapia fed a diet supplemented with phytase. The third experiment was carried out to assess the combined effects of dietary exogenous enzymes (phytase, protease and xylanase) and probiotics (Bacillus subtilis, B. licheniformis and B. pumilus) on tilapia growth performance and health. After seven weeks of feeding, tilapia fed the diet supplemented with both exogenous enzymes and probiotics showed significantly higher FBW, specific growth rate, improved FCR and better PER. The serum lysozyme activity was observed to be significantly higher in tilapia fed the probiotic supplemented diet when compared to the control group. The dietary supplementation with combined exogenous enzymes and probiotics increased intestinal perimeter ratio, microvilli count (density), diameter and subsequently resulted in higher enterocyte absorptive area in tilapia. This study demonstrates that feeding tilapia with dietary exogenous enzymes can enhance growth performance and modulate microbial community profile. In addition, supplementation with both exogenous enzymes and probiotics is capable of improving tilapia growth performance, immune parameters and intestinal morphology.

D’étiologie inconnue, les maladies inflammatoires chroniques de l’intestin, telles que la maladie de Crohn ou la rectocolite hémorragique, semblent résulter d’une réaction immunitaire inappropriée vis-à-vis de la flore commensale chez des individus génétiquement prédisposés. De ce fait, la modulation du microbiote par des probiotiques, majoritairement des bactéries lactiques commensales (lactobacilles et bifidobactéries), représente une alternative thérapeutique intéressante et a déjà conduit à un certain nombre d’essais cliniques concluants. Cependant, les effets thérapeutiques des bactéries probiotiques se sont avérés spécifiques de la souche utilisée et les mécanismes d’action de ces micro-organismes restent encore méconnus. Dans cette étude, nous nous sommes intéressés au rôle du peptidoglycane et de la voie de signalisation NOD2 dans les capacités anti-inflammatoires de certains lactobacilles probiotiques. Dans un modèle murin de colite expérimentale mimant la pathologie humaine, nous avons tout d’abord montré que les capacités protectrices de la souche anti-inflammatoire Lactobacillus salivarius Ls33 nécessitent la présence du récepteur NOD2. Ce récepteur reconnaissant les produits de dégradation du peptidoglycane, nous avons préparé du peptidoglycane hautement purifié de la souche Ls33 et montré que l’administration de ce composant, par voie intrapéritonéale ou orale, protège les souris de la colite expérimentale. Nous avons également mis en évidence que l’effet protecteur du peptidoglycane de Ls33 implique la production d’IL-10, la voie immunosuppressive de l’indoleamine 2,3-dioxygénase et le développement, au sein des ganglions mésentériques, de cellules dendritiques régulatrices CD103+ et de cellules T régulatrices CD4+FoxP3+. Nous avons montré que le peptidoglycane de Ls33 favorise, in vitro, la différentiation de cellules dendritiques naïves en cellules dendritiques productrices d’IL-10, capables de protéger, après transfert adoptif, les souris de la colite de façon NOD2-dépendante. Les capacités protectrices n’ayant pas été obtenues avec le peptidoglycane de la souche non anti-inflammatoire L. acidophilus NCFM, nous avons ensuite réalisé une analyse structurale des deux peptidoglycanes. Alors que les deux souches arborent le muropeptide M-tri-Lys-D-Asn, nous avons identifié un muropeptide additionnel libéré uniquement par Ls33, le M-tri-Lys. Bien que les deux muropeptides synthétiques activent NOD2 in vitro, seule l’administration systémique du M-tri-Lys protège les souris de la colite. Cette protection est dépendante du récepteur NOD2 mais ne nécessite pas la présence de l’adaptateur principal des récepteurs de type Toll ou TLR, MyD88. En conclusion, nos résultats indiquent que le peptidoglycane et certains de ses dérivés sont des composants actifs dans la fonctionnalité des lactobacilles probiotiques et représentent une nouvelle stratégie thérapeutique pour le traitement des maladies inflammatoires chroniques de l’intestin. / N genetically susceptible individuals, an inappropriate mucosal immune responseagainst the intestinal microbiota appears to be the principal mechanism leading to thepathogenesis of (including Crohn’s disease and ulcerativecolitis). Therefore, modulation of the luminal contents with probiotics, mainly represented bycommensal lactic acid bacteria (lactobacilli and bifidobacteria), represents an attractivetherapeutic alternative and has already led to successful clinical trials. However, theprotective effect of probiotic bacteria clearly depends on the strains used and the precisemechanisms of action of these microorganisms are still unknown.In this study, we investigated the role of peptidoglycan and NOD2 signalling in the antiinflammatorycapacity of selected probiotic lactobacilli.In a mouse model of experimental colitis mimicking human pathology, we first showedthat the protective capacity of the anti-inflammatory strain Lactobacillus salivarius Ls33require NOD2 signalling. Since this receptor senses peptidoglycan degradation products, weprepared highly purified peptidoglycan from Ls33 and showed that systemic as well as oraladministration of this component was able to rescue mice from experimental colitis. We alsodemonstrated that the protective effect of Ls33 peptidoglycan involved the production of IL-10, the immunosuppressive indoleamine 2,3-dioxygenase pathway and the expansion ofregulatory CD103+ dendritic cells and CD4+FoxP3+ regulatory T cells within mesentericlymph nodes. Furthermore, we showed that the IL-10-producing dendritic cells induced byLs33 peptidoglycan in vitro were able to protect mice from colitis in a NOD2-dependentmanner after adoptive transfer.Since the observed anti-inflammatory properties were not obtained with peptidoglycanderived from the non-anti-inflammatory strain L. acidophilus NCFM, we conducted astructural analysis of the two peptidoglycans. While the two strains exhibited the M-tri-Lys-DAsnmuropeptide, we identified an additional muropeptide released exclusively by Ls33, theM-tri-Lys. Although both synthetic muropeptides activated NOD2 in vitro, only systemicadministration of M-tri-Lys protects mice from colitis. This protective effect was NOD2-dependent but did not require the presence of MyD88, the main adapter used by Toll-likereceptors.In conclusion, our results indicate that purified peptidoglycan and specific derivedmuropeptides are active components in probiotic lactobacilli functionality and represent anew therapeutic strategy for treating inflammatory bowel diseases.

Class of 2014 Abstract / Specific Aims: Clostridium difficile associated diarrhea (CDAD) frequently occurs in patients exposed to broad-spectrum antibiotics which can result in a life threatening illness. The role of probiotics in the prevention of CDAD is not well established and many medical centers across the United States are opting to remove probiotics from common CDAD prophylaxis. We aim to evaluate the efficacy of lactobacillus probiotics during the use of broad-spectrum antibiotic therapy in the acute care setting for the prophylaxis of CDAD at Kindred Hospital. Methods: We performed a single center, retrospective data analysis efficacy trial of inpatients receiving beta-lactam, fluoroquinolone or clindamycin antibiotics from the Kindred Hospital database. Two study groups will be compared: patients who received lactobacillus probiotic therapy based on protocol since May 2011 and patients who did not receive probiotic therapy. The presence or absence of CDAD will be used to evaluate probiotic efficacy. Main Results: Of the ### patients screened, ## were assigned to the treatment group and ## were assigned to the non-treatment group, a total of ## patients were analyzed for the primary endpoint. CDAD occurred in ## patients (xx%) receiving probiotic therapy while CDAD occurred in ## patients (xx%) not receiving probiotic therapy (relative risk [RR]: xx.x; p=0.xxx). Conclusion: [Anticipated] We identified no statistically significant evidence that the use of lactobacillus was effective in the prevention of CDAD. Further knowledge of the pathophysiology of CDAD and proper antibiotic use is needed for future studies.

Orientadores: José de Assis Fonseca Faria, Adriano Gomes / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia de Alimento / Made available in DSpace on 2018-08-24T08:45:17Z (GMT). No. of bitstreams: 1 Alves_EdilmaMendesVenancio_M.pdf: 1959544 bytes, checksum: 4c5f82ea313dac511b2930d359ece024 (MD5) Previous issue date: 2014 / Resumo: Sabe-se atualmente que a alimentação tem uma relação estreita com a prevenção de doenças. Evidências indicam que o consumo de elevados teores de sal é o maior responsável pela elevação da pressão arterial na população e, consequentemente, pelas doenças cardiovasculares relacionadas. Campanhas de saúde pública, mudanças regulamentares e esforços das indústrias têm sido realizados para estimular a redução da ingestão de sódio, e assim, reduzir a incidência dos problemas ligados a ela. A incorporação de bactérias probióticas em queijos resulta em inúmeros benefícios à saúde do consumidor, o que somado aos benefícios da redução do sódio contribuiria para a manutenção de uma dieta saudável. Estas modificações, no entanto, devem ser realizadas com cautela, uma vez que o cloreto de sódio é um ingrediente que desempenha importantes funções tecnológicas nos alimentos. Este trabalho teve como objetivo avaliar os efeitos da adição dos sais cloreto de potássio e cloreto de magnésio como forma de redução de sódio, em um cream cheese com adição das culturas probióticas Lactobacillus acidophilus e Bifidobacterium lactis. Observou-se que essa redução afetou as características físico-químicas das amostras. O menor teor de umidade foi observado na amostra PROBMGCL2, que também apresentou a maior atividade proteolítica, além dos maiores teores de cálcio, proteínas e lipídios ao final de 60 dias. Os menores teores de sódio foram encontrados, no início do estudo, nas amostras que sofreram a substituição parcial deste mineral. A cultura starter empregada apresentou contagens elevadas ao final do estudo, assim como a cultura probiótica Bifidobacterium lactis que, independente do sal empregado, atingiu o número de células viáveis necessárias para que o produto seja considerado probiótico. Através do teste de Escala do Ideal foram observadas algumas diferenças quanto aos parâmetros avaliados, porém, os demais testes sensoriais evidenciaram que as amostras de cream cheese nos quais foi realizada a substituição parcial de sódio não apresentaram diferenças quanto à aceitação e ao perfil descritivo, em relação às amostras processadas sem essa substituição. Os resultados obtidos demonstram que é possível a produção de um cream cheese probiótico com redução no teor de sódio, sem que haja perdas importantes nos seus parâmetros de qualidade / Abstract: It is known that diet has a closer relationship with the prevention of diseases. Evidences indicate that consumption of large amounts of salt is the largely responsible for the elevation of blood pressure in the population and, consequently, its related to cardiovascular diseases. Public health campaigns, regulatory changes and efforts of the industries have been made to stimulate its reduction, and thus reduce the incidence of problems related to it. The incorporation of probiotic bacteria in cheese results in numerous benefits for the consumer health, which added to the benefits of reducing sodium contributes to maintain a healthy diet. These changes, however, must be made with caution, once sodium chloride is an important ingredient in food technology. This work aimed to assess the effects of adding potassium chloride and magnesium chloride as a way of reducing sodium, in a cream cheese with the addition of probiotic cultures Lactobacillus acidophilus e Bifidobacterium lactis. It was observed that this reduction affected the physicochemical characteristics of the samples. The lower moisture content was observed in the sample PROBMGCL2, which also showed the highest proteolytic activity, as well as higher levels of calcium, proteins and lipids at 60 days. The lower levels of sodium were found, at the beginning of the study, in samples that underwent the partial replacement of this mineral. The starter culture used had high scores at the end of the study, as well as probiotic culture Bifidobacterium lactis that, regardless of the salt employed, reached the number of viable cells necessary for the product to be considered probiotic. Through the Just About Right scale some differences were observed for the evaluated parameters, but other sensory tests showed that the samples of cream cheese in which the partial replacement of sodium was performed showed no differences in acceptance and descriptive profile, in relation to samples processed without this substitution. The results demonstrate that it is possible to produce a probiotic cream cheese with reduced sodium content, without coming into major losses in their quality parameters / Mestrado / Tecnologia de Alimentos / Mestra em Tecnologia de Alimentos

Orientador: Julieta Rodini Egracia de Moraes / Banca: Rogério Salvador / Banca: Fernanda Nogueira Valentin / Banca: Sérgio Henrique Canello Schalch / Banca: João Batista Kochenborger Fernandes / Resumo: A utilização de probióticos surge como uma alternativa, para o uso de antibióticos em peixes, evitando que os mesmos adoeçam. O escopo deste trabalho foi avaliar os efeitos da alimentação adicionada de probiótico contendo Bacillus amyloliquefaciens na inflamação aguda contra A.hydrophila em tilápias-do-Nilo (Oreochromis niloticus). Para tanto foram utilizados 936 exemplares de tilápias-do-Nilo (30g), distribuídas uniformemente em 12 tanques-rede sendo 78 peixes em cada. Os peixes foram alimentados durante 60 dias com ração adicionada com a bactéria probiótica em diferentes concentrações, sendo constituídos os seguintes grupos; Grupo 1 (controle) alimentado com ração basal sem adição de probiótico: Grupo 2 (T1) suplementados com 0,75 gramas de probiótico/kg de ração; Grupo 3 (T2) suplementados com 1,5 gramas de probiótico/kg de ração; Grupo 4 (T3) suplementados com 3 gramas de probiótico/kg de ração. Para o estímulo inflamatório inoculou-se na bexiga natatória dos peixes 0,5 ml de solução salina 0,65% no grupo controle e 0,5 ml x106 de uma solução, contendo A. hydrophila inativada nos demais grupos. As coletas de sangue e exsudato inflamatório foram realizadas nos tempos de 12, 24 e 48 horas após estímulo inflamatório (HPE), para as seguintes análises: variáveis hematológicas, índices de glicose basal, atividade respiratória dos leucócitos sanguíneos (burst oxidativo), características qualitativas e quantitativas do exsudato, atividade lítica das proteases do soro e atividade de aglutinação bacteriana. Os resultados foram comparados por meio de análise de variância (ANOVA) ao nível de 5% de probabilidade e a diferença entre as médias foi comparada pelo teste de Tukey. Não foram observadas variações hematológicas significativas entre os grupos de tilápias-do-Nilo tratadas e estimuladas e o grupo controle, o mesmo pode ser observados... / Abstract: The use of probiotics arises as an alternative to the use of antibiotics in fishes, preventing them from becoming sick. The scope of this study was to evaluate the effects of food with added probiotic containing Bacillus amyloliquefaciens in acute inflammation against A.hydrophila in the Nile-tilapia (Oreochromis niloticus). To that end, there were used 936 copies of the Nile-tilapia (30g), evenly distributed in 12 net tanks with 78 fish in each. The fishes were fed for 60 days with food added with the probiotic bacteria in different concentrations, with the following groups being formed; Group 1 (control) fed with basal food without added probiotic: Group 2 (T1) supplemented with 0.75 grams of probiotic / kg food; Group 3 (T2) supplemented with 1.5 grams of the probiotic / kg food; Group 4 (T3) supplemented with 3 grams of probiotic / kg food. For the inflammatory stimulus it was inoculated in the swimming bladder of fish 0.5 ml of saline solution 0.65% in the control group and 0.5 ml x106 of a solution containing inactivated A. hydrophila in the other groups. Blood collections and inflammatory exudate were held in the periods of 12, 24 and 48 hours after the inflammatory stimulus (HPE), for the following analysis: haematological variables, basal glucose levels, respiratory activity of sanguine leukocytes (oxidative burst), qualitative and quantitative characteristics of the exudate, lytic activity of serum proteases and agglutination bacterial activity. The results were compared using analysis of variance (ANOVA) at 5% probability and the difference between the means was compared by Tukey test. There were no significant hematological changes between the groups of Nile-tilapia treated and stimulated and the control group, the same thing can be observed in glycemic indeces and respiratory activity of blood leucocytes. The inflammatory exudate was characterized by the predominant accumulation ... / Doutor

Lactic acid bacteria are natural habitants of human gastrointectinal tract. Among the most important are bacteria of genus Lactobacillus and genus Bifidobacterium that contain a lot of probiotic species. Probiotic species are used as food supplements. This work was focused on DNA separation from crude cell lysates of 4 food supplements using magnetic carrier P(HEMA-co-GMA) covered by carboxyl groups. DNA was reversible adsorbed to the carriers in the presence of PEG 6000 (16%) and NaCl (2 M) (final concentrations) and eluted into TE buffer. Lysis of cells from food supplements was performed by lysozyme, SDS and proteinase K. The amount of lysozyme was optimalized. Concentration of separated DNA was measured by spectrophotometric method. The amount of isolated DNA was suitable for PCR. Isolated DNA was used for PCR with universal primers, PCR specific for genus Lactobacillus and genus Bifidobacterium and for 9 different species-specific PCRs: Lactobacillus rhamnosus, Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus fermentum, Lactobacillus casei/paracasei, Streptococcus thermophilus, Bifidobacterium longum, Bifidobacterium bifidum and Bifidobacterium infantis. Amplicons were detected by agarose gel electrophoresis (1,8%). It was shown that DNA amplification methods are quick and precise for identification of studied species. The results of bacteria identification were compared with data provided by the manufacturer. In all food supplements, bacteria of genus Lactobacillus and Bifidobacterium were detected. However, only some species provided by manufacturer were identified by PCR in each tablet.

Lactobacilli are dominant bacteria of the vaginal flora. Lactobacillus-containing probiotics products are used for the treatement and profylaxis of bacterial urogenital infections. This work is focused on DNA identification and species identification of probiotic bacteria in 5 different vaginal tablets using molecular-genetic methods. Total DNA isolated from complex matrix of vaginal tablets was used for amplification in polymerase chain reaction. DNA was isolated from crude cell lysates by magnetic particles P(HEMA-co-GMA) and by method of phenol extraction. Identification of species of probiotic bacteria was verified using genus-specific and species-specific PCRs. Results of bacterial identification obtained by PCR were compared with declared specification given by producers. Bacteria of genus Lactobacillus were proved in all tablets whereus species identification was in accordance with the stated composition in 1 tablet only.

Orientador: Katia Denise Saraiva Bresciani / Resumo: A criptosporidiose, uma das principais causas de diarreia infantil, é causada por parasitos do Filo Apicomplexa pertencentes ao gênero Cryptosporidium. A falta de medicamentos eficazes está motivando pesquisas para desenvolver tratamentos alternativos. Para este objetivo, o impacto dos probióticos no curso da criptosporidiose foi investigado. A microbiota intestinal nativa de camundongos imunossuprimidos livres de patógenos específicos foi inicialmente esgotada com antibióticos administrados por via oral. Um produto probiótico comercialmente disponível destinado ao consumo humano foi subsequentemente adicionado à água potável. Os camundongos foram infectados com oocistos de Cryptosporidium parvum. Em média, os camundongos tratados com probiótico desenvolveram uma infecção mais grave. Os probióticos alteraram significativamente a microbiota fecal, mas não foi observada associação direta entre a ingestão de bactérias probióticas e sua abundância na microbiota fecal. Esses resultados sugerem que os probióticos alteram indiretamente o microambiente intestinal ou o epitélio intestinal de maneira a favorecer a proliferação de C. parvum. / Abstract: Cryptosporidiosis, a leading cause of infant diarrhea, is caused by apicomplexan parasites classified in the genus Cryptosporidium. The lack of effective drugs is motivating research to develop alternative treatments. To this aim, the impact of probiotics on the course of cryptosporidiosis was investigated. The native intestinal microbiota of specific pathogen-free immunosuppressed mice was initially depleted with orally administered antibiotics. A commercially available probiotic product intended for human consumption was subsequently added to the drinking water. Mice were infected with Cryptosporidium parvum oocysts. On average, mice treated with probiotic developed a more severe infection. The probiotics significantly altered the fecal microbiota, but no direct association between ingestion of probiotic bacteria and their abundance in fecal microbiota was observed. These results suggest that probiotics indirectly altered the intestinal microenvironment or the intestinal epithelium in a way that favors proliferation of C. parvum. / Doutor

The crustacean Artemia franciscana represents a potential experimental model for human studies. The aim of the project was to assess whether Artemia could be used as a model for investigation of probiotic properties. For all the experiments, Artemia cysts were rehydrated, decapsulated and allowed to hatch for 28 hours before the developed larvae (nauplii) were challenged and/or treated with probiotics; measurement of survival rate occurred after further 24 and 48 hours. Interestingly, administration of L. reuteri 17938 during an initial study showed that the probiotic rescued Artemia from spontaneous death occurring in the absence of any established and chosen challenge in a dose-dependent manner. Assuming that Artemia death was related to some kind of stress, the mode of action by means of which L. reuteri provided protective effects was investigated. Heat-treated and bead-beaten L. reuteri positively affected Artemia survival rate to a greater extent than live L. reuteri, with the highest improvement occurring during administration of bead-beaten L. reuteri. In particular, administration of different fractions of the bead-beaten L. reuteri cultures to Artemia allowed for identification of the molecule responsible for amelioration of Artemia fitness in bacterial components ranging between 3 and 300 kDa in weight. Supernatants obtained from exudates of plate-grown bacteria instead revealed itself to be lethal when added in amounts corresponding to 10⁷ CFU/ml of the bacterial culture or higher. Further studies on a genetic and immunological level on Artemia are required in order to elucidate the complex interactions establishing among the host, the probiotic and the environment. However, based on the data gathered, it is possible to suggest that Artemia can be used as a potential chronic stress model, for example as aging or starvation models. Besides this, L. reuteri shows to provide an overall protective effect against this stress, although differences in the extent of the protection were observed according to the growth protocol and the killing mode of bacterial cultures. Also, the lethality of the supernatants demonstrates once again that the probiotic activity is the result of multiple and intertwined biological pathways, sometimes in contrast to one another.

Bakgrund: Antibiotikabehandling kan medföra gastrointestinala besvär hos patienter. En vanlig orsak till detta är bakterien Clostridium difficile som normalt kan återfinnas i tarmfloran. Vid antibiotikabehandling kan flera av tarmflorans goda bakterier slås ut vilket kan resultera i att C. difficile växer till sig och genom toxiner ge gastrointestinala besvär. Detta kan orsaka patienter onödigt lidande och kostar hälso- och sjukvården mycket pengar årligen. Probiotika består av levande mikroorganismer och det finns teorier om att dessa kan ha en positiv inverkan på tarmfloran genom stabilisering av den samt förhindrar överväxt av C. difficile i floran.   Syfte: Syftet var att undersöka om behandling med probiotika kan förebygga C. difficile infektion och/eller lindra gastrointestinala besvär orsakade av C. difficile i samband med antibiotikabehandling.  Metod: Beskrivande litteraturöversikt. Litteratursökning gjordes i CINAHL och PubMed. Elva randomiserade kontrollerade studier utgjorde resultatet i litteraturöversikten efter att ha genomgått en kvalitetsgranskning. Resultat: En statistisk signifikant skillnad gällande förebyggande av C. difficile fanns i tre av de elva inkluderade studierna. Probiotika som symtomlindring mot C. difficile visade på en signifikant skillnad avseende diarré och lösa avföringar i fyra studier med signifikant fler fall i kontroll- än interventionsgrupperna. Andra symtom som undersöktes i sammanlagt sju studier var utspänd buk, buksmärta, illamående, kräkning och flatulens. Slutsats: Litteraturöversikten påvisade att probiotika i vissa fall kan ha effekt mot infektion orsakad av C. difficile i samband med antibiotikabehandling. Effekten visar sig i form av lindrande effekt på vissa gastrointestinala besvär. Litteraturöversikten kunde dock inte påvisa tillräcklig evidens på grund av varierande resultat i de inkluderade artiklarna. Det gör att probiotika i nuläget inte är aktuellt för implementering inom sjukvården i samband med antibiotikabehandling för att förebygga eller lindra infektion av C. difficile. / Background: Patients treated with antibiotics can experience gastrointestinal side effects. A common cause of the side effects is the bacterium Clostridium difficile. C. difficile can normally be found in the intestinal human flora. Antibiotic treatment can cause imbalance in the intestinal flora because antibiotics sometimes eliminate several of the good bacteria in the gastrointestinal microbiome. This can cause an overgrowth of C. difficile and through its toxins cause gastrointestinal side effects for the individual. The side effects of antibiotics and C. difficile can cause individual suffering and cost healthcare a lot of money annually. Probiotics contain living microorganisms and there are theories that these microorganisms can have a positive effect on the intestinal human flora by stabilizing the gastrointestinal microbiome and preventing overgrowth of C. difficile in the human flora.   Aim: The aim was to investigate if treatment with probiotics could prevent C. difficile infection and/or relieve the occurrence of gastrointestinal side effects caused by C. difficile in patients treated with antibiotics.    Method: A descriptive literature review. Data collection was made in CINAHL and PubMed. Eleven randomized controlled trials were included in this literature review after a quality review.   Results: A statistically significant difference in the prevention of C. difficile was found in three of the included articles. Probiotics used for relief of symptoms caused by C. difficile showed a significant difference in four studies that examined loose stools and diarrhea with more cases in the control group than the intervention group. Other symptoms examined in a total of seven articles were distended abdomen, abdominal pain, nausea, vomiting and flatulence.  Conclusion: This literature review proved that probiotics in some cases may have an effect on infections caused by C. difficile during treatment with antibiotics. The literature review could not prove sufficient evidence due to varying results in the included studies. That makes probiotics at the present time not relevant for implementation in healthcare services during treatment with antibiotics for prevention of C. difficile.