Probiotics and the Treatment of Infectious Diarrhea

Jonathan E. Teitelbaum, MD


Pediatr Infect Dis J. 2005;24(3):267-268. 

In This Article

Clostridium difficile- Related Diarrhea

The use of probiotics for treatment of C difficile diarrhea is a logical step, particularly given the success of fecal enemas for relapsing cases. An early case report described 4 children with relapsing C difficile who responded to supplement with LGG. C difficile toxins A and B are cytotoxins; toxin A also acts as an enterotoxin. S. boulardii inhibits toxin A and B enteritis by releasing a 54-kDa protease that cleaves these toxins and their receptor for the brush border membrane.[9]

The ability of probiotics to prevent C difficile -associated diarrhea is supported by a study of 138 hospitalized adults receiving antibiotics who were randomized to receive probiotics or placebo. Of those who developed diarrhea, 2.9% of the probiotic group were positive for C difficile toxins, compared with 7.25% of the placebo group. When all stool samples were tested, only 46% of the probiotic group were toxin-positive versus 78% of the placebo group.[10]

The use of probiotics as adjuvant therapy in prevention of recurrent C difficile diarrhea has been demonstrated. S. boulardii was used in conjunction with standard antimicrobial treatment in a placebo-controlled study of 124 adult patients with C difficile diarrhea. Sixty-four patients were infected from their initial presentation, whereas 60 had a prior episode of disease. In those with an initial episode, there was no difference in recurrence rate; however, in patients with prior C difficile disease, the recurrence rate was significantly less in the group receiving the probiotic.[11]