Monday May 18, 2009
Probiotics for the prevention/treatment of Antibiotic Associated Diarrhea (AAD) and Clostridium difficile-Associated Diarrhea (CDAD)?

Probiotics are defined as live organisms (bacteria, yeast) that provide beneficial effects to the health of a host when ingested. The effects of probiotics vary depending on the type/strain (e.g. S. boulardii, Lactobacillus, Bifidobacterium bifidum), dose, route, and frequency of delivery. Mechanisms of action include elaborating antibacterial molecules e.g. bacteriocins to inhibit the growth and virulence of enteric bacterial pathogens; enhance the mucosal barrier to prevent the binding of enteric pathogens; by promoting an adaptive immune response; and activating receptors in the enteric nervous system, thus promoting pain relief.

C. difficile diarrhea often presents during or after a short course of antibiotic therapy. Offending antibiotics include fluoroquinolones, beta-lactam, betalactamase, amoxicillin, and clindamycin. The current literature has shown promise and potential benefit in the use of probiotics, specifically S. boulardii and Lactobacillus, as a means to restore GI flora and prevent/treat AAD. However, the data lacks statistical power and poor study design.

Recommendation: Probiotics should not be routinely used for the prevention/treatment of AAD and CDAD until further studies are performed.



References: click to get abstract

1. Sherman PM, etal. Unraveling Mechanisms of Action of Probiotics - Nutr Clin Pract 2009; 24(1):10-14.

2. Imhoff A, etal. - Is There a Future for Probiotics in Preventing Clostridium difficile–Associated Disease and Treatment of Recurrent Episodes? - Nutr Clin Pract, February 1, 2009; 24(1): 15 - 32.

3. C. L. Rohde, V. Bartolini, and N. Jones - The Use of Probiotics in the Prevention and Treatment of Antibiotic-Associated Diarrhea With Special Interest in Clostridium difficile-Associated Diarrhea - Nutr Clin Pract, February 1, 2009; 24(1): 33 - 40.