Antibiotic-associated diarrhea (AAD) is caused by alteration in bacterial flora which changes carbohydrate metabolism, reduces absorption of fats, and results in osmotic diarrhea. AAD may lead to Clostridium difficile (C. difficile) colitis following proliferation of this organism in the colon which can cause abdominal pain and life-threatening inflammation of the colon. Antibiotic therapy is the key factor predisposing patients to C difficile infection. Research suggests that some probiotics have a protective effect for antibiotic associated diarrhea and C difficile infection.
Specific probiotic reduces risk of antibiotic-associated diarrhea:
Researchers analyzed 5 randomized clinical trials (n=1076) of Saccharomyces boulardii (S boulardii) and found a significantly protective effect for antibiotic-associated diarrhoea (AAD). Compared with placebo, S boulardii was associated with a 57% risk reduction in AAD. Saccharomyces boulardii reduced the absolute risk of antibiotic-associated diarrhea (AAD) from 17.2% to 6.7%. (1)
Several probiotics are effective for antibiotic-associated diarrhea (AAD):
Probiotics such as Saccharomyces boulardii and lactobacillus may have a protective effect against antibiotic-associated diarrhea (AAD) caused by bacterial flora alteration in the gut. A review of the literature by Cremonini, F et al found 3 randomized, double-blind, controlled clinical trials that reported beneficial effects of S boulardii in AAD. Two separate double-blind controlled studies showed the benefits of Lactobacillus acidophilus and bulgaricus. Some other studies, not double-blind, report beneficial effect of Lactobacillus rhamnosus GG, Bifidobacterium longum and Enterococcus faecium SF68. (2)
A meta-analysis reviewed controlled trials on probiotics:
McFarland, LV et al reviewed 25 randomized controlled trials, and found that S. boulardii and L. rhamnosus GG, or 2 strains of Lactobacuillus species or a combination of Lactobacillus acidophilus and Bifidobacterium at an average dose of 3×109 for about 2 weeks resulted in a 57% reduction on antibiotic associated diarrhea (3). However,the higher doses of organisms in probiotics (over 1010/day) had a higher efficacy rate for ADD. McFarland, LV et al also reviewed 6 randomized controlled trials of oral vancomycin or metronidazole plus probiotic therapy (or placebo) with average dose of 5×1010 at a duration of 3-5 weeks for the treatment/prevention of clostridium difficile colitis (CDD). S. boulardii significantly decreased the recurrence of CDD with a relative risk reduction of 41% but no other types of probiotics were effective for prevention or recurrence of CDD. (3)
Conclusion: Antibiotic Associated Diarrhea and Clostridium difficile Colitis
- Szajewska, H et al published that compared with placebo, Saccharomyces boulardii reduced the absolute risk of antibiotic-associated diarrhea (AAD) from 17.2% to 6.7% (1).
- Cremonini, F et al found 3 double-blind controlled trials which showed improvement of AAD with Saccharomyces boulardii, and 2 additional trials found Lactobacillus acidophilus and bulgaricus to be beneficial (2). He also found other non-blinded trials showing beneficial effect of Lactobacillus rhamnosus GG, Bifidobacterium longum, and Enterococcus faecium SF68 (2).
- McFarland, LV et al reviewed 25 randomized controlled trials, and found that S. boulardii and L. rhamnosus GG, or 2 strains of Lactobacuillus species or a combination of Lactobacillus acidophilus and Bifidobacterium at an average dose of 3×109 for about 2 weeks median duration resulted in a 57% reduction on antibiotic associated diarrhea. The higher doses of organisms in probiotics (over 1010/day) had higher efficacy for ADD. (3)
- McFarland, LV et al reviewed 6 randomized controlled trials of oral vancomycin or metronidazole plus probiotic therapy (or placebo) with average dose of 5×1010 at a duration of 3-5 weeks for the treatment/prevention of clostridium difficile colitis (CDD). S. boulardii significantly decreased the recurrence of CDD with a relative risk reduction of 41% but no other types of probiotics were effective for prevention or recurrence of CDD. (3)
References:
1.Szajewska H, Mrukowicz J. Meta-analysis: non-pathogenic yeast Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. Aliment Pharmacol Ther 2005 Sep 1; 22(5): 365-72. http://www.ncbi.nlm.nih.gov/pubmed/16128673
2.Cremonini F, Di Caro S, Santarelli L, et al. Probiotics in antibiotic-associated diarrhoea. Dig Liver Dis. 2002 Sep;34 Suppl 2:S78-80. http://www.ncbi.nlm.nih.gov/pubmed/12408447
3.McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol. 2006 Apr;101(4):812-822. http://www.ncbi.nlm.nih.gov/pubmed/16635227