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

David A. Johnson, MD


September 20, 2013

In This Article

Yeast and Nonyeast Products

Saccharomyces is a yeast, which, in hospitalized patients with indwelling catheters, poses a significant risk. In a study of 37 patients with disseminated Saccharomyces, 67% had been taking a probiotic with Saccharomyces. Of interest, another 7% of the positive patients had never taken the probiotic but were associated with other patients who were taking it. So, this yeast may be distributed in the local environment even if the patients are not taking it. In patients with indwelling catheters and in immunocompromised patients, this product is not recommended. With respect to routine probiotic use in hospitalized patients, we need to temper this in immunocompromised patients and in those with indwelling catheters.

How about nonyeast products such as Lactobacillus and Bifidobacterium? A study that looked at these products in patients with acute pancreatitis was published in The Lancet [4]in 2008. It was a brilliant double-blind, randomized study that looked at outcomes of benefit, with mortality being the primary endpoint. In the patients who were receiving the probiotics, the mortality rate was 16% compared with 6% in the placebo group. Of interest, 8 of these deaths were related to intestinal infarction. This emphasizes that even the use of the nonyeast, bacterial products needs to be tempered in severely ill patients. Hospitals that are considering the routine use of probiotics should review the data closely before making any decisions.


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