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

David A. Johnson, MD


September 20, 2013

In This Article

More Enthusiasm Than Data

What is the bottom line? The PLACIDE study showed that for hospitalized patients, we have no evidence of benefit from probiotics for reducing antibiotic-related or C difficile diarrhea. We will wait and see whether this changes practice, but I would urge caution on the part of healthcare systems that are considering routine use of probiotics in their patients. The complications associated with probiotics, such as the yeast probiotics and some of the bacterial products, suggest that in patients who are immunocompromised, severely ill, or have indwelling catheters, the use of probiotics needs serious consideration before being put into practice.

With respect to diverticulitis, probiotics may have a role when combined with mesalamine. Who knows? We have good evidence on mesalamine. The possible benefit of this combination is very tantalizing if you can get your patients to comply with taking these products for a 10-day stretch once a month for 12 months.

The benefits of probiotics have generated a lot more enthusiasm than data. With respect to gut microecology, we are just scratching the surface of a huge iceberg. It will set the tone of medicine going forward, but I would love to see more evidence before this evolves into routine practice. I will leave it to your good clinical judgment as to whether to apply this to your practice. I'm Dr. David Johnson. Thanks again for listening.


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