https://immattersacp.org/weekly/archives/2012/11/13/4.htm

Probiotics reduced C. diff infections, review finds

Giving probiotics to patients taking antibiotics reduced the risk of Clostridium difficile-associated diarrhea (CDAD), according to a new review.


Giving probiotics to patients taking antibiotics reduced the risk of Clostridium difficile-associated diarrhea (CDAD), according to a new review.

Reviewers included 20 trials with more than 3,800 adult or pediatric patients who were receiving antibiotics and were randomized to a specified probiotic or placebo or no treatment control. They found that probiotics reduced the incidence of CDAD by 66% (pooled relative risk, 0.34 [95% CI, 0.24 to 0.49]). Results were published online by Annals of Internal Medicine on Nov. 13.

annals.jpg

Assuming a 5% incidence of CDAD in patients taking antibiotics (the median risk in the studies' control groups), probiotic prophylaxis would prevent 33 cases of CDAD per 1,000 patients, the researchers calculated (95% CI, 25 to 38). Adverse events were lower in the probiotic-treated patients (9.3% vs. 12.6% of controls) and no trial reported a serious adverse event attributable to probiotics. Using multiple species of probiotics rather than a single species appeared to result in larger effects, but the finding was not consistent across studies, so further research is needed on this issue.

The authors concluded that moderate-quality evidence suggests a large reduction in CDAD from probiotic prophylaxis. A larger sample size would be required to rate the quality of evidence as better than moderate, they noted. The review was limited by missing data on CDAD status in some patients. However, the authors conducted a stringent assessment of the worst-plausible assumptions with regard to that missing data and found the results still robust.

“Given the low cost of probiotics and the moderate-quality evidence suggesting the absence of important adverse effects, there seems little reason not to encourage the use of probiotics in patients receiving antibiotics who are at appreciable risk for CDAD,” the authors concluded.