Probiotics, Antibiotic Associated Diarrhea, Clostridiumdium Difficile

Clinical Notes : Pharmacology

37. Probiotics,

Antibiotic Associated Diarrhea,

Clostridium Difficile

Proven benefits

Probable benefits

No evidence of benefit

Clostridium difficile

- References -

- CPD Quiz -

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

Probable benefits (no conclusive data yet)

shorten duration of infectious diarrhoea
reduce the likelihood of premature babies developing NEC
reduce bloating and flatulence in some people with IBS.
- NICE recommendation : 4 week trial for effect

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

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

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