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


Probable benefits (no conclusive data yet)


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

cochrane library.jpg

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.



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


Probiotics for the prevention of antibiotics-associated diarrhea in children

Hania Szajewska,et al.

European Society for Paediatric Gastroenterology Hepatology and Nutrition

March 2016


Ireland notes.png

CPD Quiz and Certificate

This activity attracts 1,0 CPD point

37. probiotics.jpg

Scroll down the box above to view its entire content

All users who successfully complete the quiz are e-mailed a copy of their personalised CPD certificate.