Probiotic Supplements Shown To Be Best Approach To Prevent C-difficile Infection In Hospitalized Patients 08/30/12

It is well documented that antibiotic-associated diarrhea (AAD) is a common complication of antibiotic use. This problem is reported to affect 5–70% of adult patients taking antibiotic drugs.

In 10–25% of cases, AAD is caused by bacterium known as Clostridium difficile, resulting inC. difficile-associated diarrhea, CDAD). CDAD is particularly important in elderly hospitalized patients as they represent the subpopulation with the highest risk for this problem.

The severity of AAD may range from mild forms to a life-threatening condition. CDAD is often associated with high mortality rates, as well as increased in-hospital length and health-care costs. As such, researchers are looking for measures to limit the in-hospital spread of C. difficile infection.

A number of randomized controlled trials and meta-analyses, have shown that the administration of probiotic supplements to patients on antibiotics has prevented the development of AAD and CDAD. Probiotic supplements are able to do this by restoring the altered intestinal microflora, enhancing immune response, and clearing pathogens and their toxins from the intestinal tract. There are no drugs that are able to produce these highly desirable effects.

The question is what probiotic bacterial strains work best to prevent AAD and CDAC. This is a topic of intensive investigation at this time. Of interest is the fact that a yeast known as Saccharomyces boulardii (S. boulardii), as opposed to a bacterium, has shown various beneficial properties in the intestinal lumen, including a direct inhibitory action against toxins produced by C. difficile. In clinical trials, the administration of S. boulardii has shown a 53% reduction in risk of developing AAD and a reduction in CDAD recurrence in affected patients, who were administered the antibiotic drugs metronidazole or vancomycin.These encouraging results have lead researchers to design on-going clinical trials to try to establish the best probiotic combination supplement that would prevent AAD and CDAD. This is especially important for older, hospitalized patients (1).

After reviewing much of the evidence on this subject, as presented by 2011 by Wallace et al (see reference number 2), it appears that there are a wide spectrum of benefits available from taking probiotics in regards to health-promotion and disease prevention purposes. In general, it appears that a good probiotic supplement should contain various strains of bacteria, ensuring the presence of the bifidobacteria and lactobacilli. For example, the probiotic combination supplement shown to improve intestinal barrier function in animals with colitis included a commercial supplement that contains Lactobacillus casei, Lactobacillus plantarum, Lactobacillus acidophilus, and Lactobacillus delbrueckii subspecies bulgaricus, Bifidobacterium longum, Bifidobacterium breve, Bifidobacterium infantis, Streptococcus salivarius subspecies thermophilus (2).  The inclusion of S boulardii also makes sense in cases where antibiotics are being taken concurrently (1).

 

Reference:

1.  S Pietro Pozzoni MD; Alessia Riva MD; Alessandro Giacco Bellatorre MD; Maria Amigoni MD; Elena Redaelli MD; Anna Ronchetti MD; Mariangela Stefani MD; Rosangela Tironi MD; Edoardo Ennio Molteni MD; Dario Conte MD; Giovanni Casazza PhD; Agostino Colli MD. Saccharomyces boulardii for the Prevention of Antibiotic-Associated Diarrhea in Adult Hospitalized Patients: A Single-Center, Randomized, Double-Blind, Placebo-Controlled Trial. The American Journal of Gastroenterology. 2012;107(6):922-931.

 

2. Wallace TC et al. Human gut microbiotica and its relationship to health and disease. Nutrition Reviews 2011. Vol 69 (7):392-403

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