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

Secondary Prevention

Five studies have investigated probiotic use as a secondary prophylaxis against CDI relapse, with only two showing a significant effect. The first study established that in patients who had experienced a relapse of CDI, S. boulardii in combination with standard CDI treatment prevented further disease relapse [relative risk (RR) 0.43, 95% CI: 0.2–0.97].[41] The second study, carried out by the same group, replicated these results and demonstrated that high-dose vancomycin (2 g/day) and probiotic was the most effective combination. A lower dose of vancomycin (500 mg/day) reduced CDI recurrence (21 versus 62% placebo), but at the expense of a longer mean duration of treatment.[42] The remaining studies are limited by small sample sizes and therefore underpowered, making it difficult to draw a meaningful conclusion.[43–45]