Probiotics for Diarrhea: Are 'Bug-Drugs' the Answer?

David A. Johnson, MD


September 20, 2013

In This Article

Probiotics and Antibiotic-Associated Diarrhea

Let me give you a couple of recent articles that put in perspective some new information about probiotics.

One is the PLACIDE study.[1] This study was conducted specifically to look at antibiotic-associated diarrhea and Clostridium difficile  diarrhea. There has been a tremendous amount of interest on the part of hospitals about whether probiotics could be helpful in reducing antibiotic-associated diarrhea, in particular C difficile diarrhea. A meta-analysis was published in JAMA,[2] and then another analysis[3] that was focused on C difficile suggested a risk reduction of approximately 42% for antibiotic-associated diarrhea and about 66% for C difficile diarrhea. This prompted a lot of hospital systems to question whether they should be giving antibiotics and probiotics at the same time. C difficile has become a tremendous nosocomial infection. It has surpassed methicillin-resistant Staphylococcus aureus (MRSA). In the United States alone, it accounts for nearly 30,000 deaths per year, which approximates the number of traffic deaths that we have in the United States. Put into this perspective, it starts to raise some questions. C difficile infections also extend hospital stays and affect reimbursements. There are many rational reasons to look at ways that we can prevent nosocomial infections, especially C difficile.

What did the PLACIDE study find? The PLACIDE study was conducted in the United Kingdom's national health system. In a rigorous randomized, double-blind, placebo-controlled trial, nearly 3000 hospitalized patients were given Lactobacillus acidophilus -- in a colony count of 6 x 1010, a sizeable amount of active therapy -- vs placebo, for 21 days. All patients were age 65 years or older, and all were receiving antibiotics. The time frame for antibiotic-related diarrhea was 8 weeks, and for C difficile it was 12 weeks. The study used an intention-to-treat analysis. The findings of the largest study that we have to date on probiotics showed no difference in antibiotic-related diarrhea or C difficile diarrhea between the probiotic and placebo groups.


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