Probiotics for the Prevention and Treatment of Clostridium difficile in Older Patients

Jasmin Islam; Jonathan Cohen; Chakravarthi Rajkumar; Martin J. Llewelyn


Age Ageing. 2012;41(6):706-711. 

In This Article


Although endocarditis has been reported following the consumption of L. rhamnosus,[47] no cases of systemic bacteraemia have been reported in trials using a probiotic test strain in otherwise healthy adults, including trials involving older people. Concerns remain about the use of probiotics in severely immunocompromised patients but the significance of this is not clear. In a multicentre study carried out in intensive care, 298 patients with severe pancreatitis were randomised to receive a multispecies probiotic preparation or placebo. The rate of intestinal ischaemia and mortality rate were higher in the active group versus placebo (16 versus 6% placebo, RR: 2.53 95% CI: 1.22–5.25).[48] However, in contrast, a study involving mechanically ventilated patients in a similar setting found no difference in 28-day mortality between the active multi-species probiotic group (25.3%) and placebo (23.7%).[49] Therefore, the exact nature of immune compromise may be significant as probiotics have been used in pre-term neonates and HIV patients with no reported serious adverse events.[50]