Clinical Notes : Pharmacology

37. Probiotics,

Antibiotic Associated Diarrhea,

Clostridium Difficile

Proven benefits

  • reduced risk of Antibiotic Associated Diarrhoea (42%)

    • reduced risk of C diff-associated diarrhoea (64%)

    • should be taken for the duration of antibiotic treatment and for up to 14 days after

  • reduced missed work/school days because of respiratory illness and acute otitis media from Lactobacillus reuteri , L. casei , and L. rhamnosus

  • reduced symptoms of lactose intolerance

    • stomach cramps, flatulence and diarrhoea improved from Lactobacillus Acisophilus

  • reduced treatment time and delayed recurrence of bacterial vaginosis

  • reduced incidence of adverse reactions (diarrhea, bleeding, taste disturbances) from triple and quadruple H. pylori treatment regimens, and consequently improved compliance, from Bifidobacterium and L. casei

 

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Probable benefits (no conclusive data yet)

 

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No evidence of benefit for :

  • Babies with colic

  • Boosting immune system

    • There's no need to "rebalance" gut bacteria in a perfectly healthy individual, despite the claims in some marketing material. 

  • Vaginal thrush

  • Crohn'd Disease and Ulcerative colitis

  • Eczema

  • Dyslipidemia

 

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Clostridium difficile

  • Mainly affects elderly hospitalised patients, but community acquired infection and infection in pregnant women and children also occurs.

  • 15-39% of infections can cause severe diarrhoea and death

  • Any antibiotic can increase risk of infection, but broad spectrum antibiotics such as clindamycin and 3rd generation cephalosporins are associated with a greater risk

  • If suspected, stop any antibiotics and PPIs if possible and send sample with clinical details to the lab requesting C.diff assay

  • Diagnosis x ≥1 episode of diarrhoea, not attributable to any other cause, with a positive stool sample

  • Treatment

    • Often resolves with withdrawal of antibiotics

    • Consider vancomycin or metronidazole

  • Usually resolves in 3-7 days

  • Relapses are common

 
 
 
 
 

Probiotics for the prevention antibiotic-associated diarrhea in children

Goldenberg JZ, Lytvyn L, Steurich J, Parkin P, Mahant S, Johnston BC

Cochrane review. December 2015.

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Probiotics for the Prevention and Treatment of Antibiotic-Associated Diarrhea. A Systematic Review and Meta-analysis.

Susanne Hempel, Sydne J. Newberry, Alicia R. Maher, Zhen Wang, Jeremy N. V. Miles,  Roberta Shanman, Breanne Johnsen, Paul G. Shekelle. JAMA 2012;307(18):1959- 1969. May 2012

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Probiotics for the prevention of antibiotics-associated diarrhea in children

Hania Szajewska,et al.

European Society for Paediatric Gastroenterology Hepatology and Nutrition

March 2016

Access

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