Probiotics in the Prevention of Antibiotic-Associated Diarrhea

 

Probiotics -       “mono- or mixed culture of live micro-organisms which, applied to animal or man, affects beneficially the host by improving the properties of the indigenous micro flora.” (5)

-Be of human origin                                           -Be viable in delivery vehicles

-Exhibit non-pathogenic properties                      -Modulate the immune system

-Persist within the gastrointestinal tract   -Be stable in acid and bile

-Produce antimicrobial substances                      -Influence metabolic activities

-Adhere to target epithelial tissue (1)

 

Examples:  

Lactobacillus GG                       -human isolated strain

-long record of safety

     

Saccharomyces boulardii            -non-pathogenic yeast

-first used in the 1950’s to treat diarrhea in France

 

Antibiotic-Associated Diarrhea

Occurs in 5-30% of patients receiving antibiotics

Usually occurs 2-8 weeks after exposure to antibiotics

Higher association with the use of B-lactams, clindamycin and cephalosporins

Higher association with the use of multiple antibiotics

Increased risk in the elderly

10-20% of cases caused by clostridium difficile

Majority caused by unknown etiology (4)

Leads to:

Longer hospital stays (8 days on average)

Higher cost of hospital care ($2000-4000 per stay and $1 billion per year)

Fivefold increase in the indcidence of other nosocomial infections

Threefold increase in mortality (5)

           

The use of probiotics including S. boulardii and LGG in randomized control trials and meta-analysis shown to:

-          decrease the occurrence of antibiotic-associated diarrhea

-          decrease the severity of C. difficile diarrhea

-          possible benefit in treatment of IBD, IBS, H. pylori eradication, constipation, atopic eczema, and healthy subjects

 

Start probiotics with the initiation of antibiotics and continued until 4 days to 2

wks after discontinuation of therapy

-          dose 2 x 1010 - 6 x 1010 for adequate amount

-          caution in use of the severely ill or immunocompromised host

-           

Need for larger randomized control trials in the future to confirm benefit but due to safety and low cost of probiotics, there is enough data to encourage use in prevention of antibiotic-associated diarrhea.