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

David A. Johnson, MD


September 20, 2013

In This Article

A Couple of Caveats

Before we throw this study under the bus and say that this is the absolute end and that probiotics should not be used, a few important caveats must be considered. One is that these investigators did not see the anticipated frequency of diarrhea. They powered their study for a 20% rate of diarrhea but found only 10%, so the actual diarrhea rate was lower than expected. The same was true for the rate of C difficile diarrhea. They anticipated 4% but found only 1%. So, there may be something unique about this study, but they probably overpowered their study. It's hard to say that this study could not be replicated, but with the number of patients and the size of the study -- 5 centers and a well-contained database analysis from the United Kingdom -- it is unlikely that we will see this replicated in the near future.

A couple of other caveats must be mentioned before you rush out and start administering probiotics to hospitalized patients. The Saccharomyces boulardii data suggested that probiotics may be inferentially better as prevention rather than as active treatment. S boulardii (Florastor®) is a yeast product that has the ability to prevent binding of toxin A through a proteolytic digestion that inactivates both toxins A and B. So, with respect to C difficile, there is some scientific rationale for using this product.

The scientific data were fairly mixed. In fact, the American College of Gastroenterology guidelines recently suggested in retrospect that probably only the data from the post-hoc analyses and certain subset analyses showed any benefit, and dismissed it as an active recommendation for the treatment or prevention of relapse.


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