07 Jun Probiotics for the prevention of antibiotic-associated diarrhea and C.diff among hospitalized patients
MedicalResearch.com eInterview with: Dr. Reena Pattani MD
Department of Medicine
St. Michael’s Hospital
30 Bond Street, Toronto ON M5B 1W8
MedicalResearch.com: What are the main findings of the study?
Dr. Pattani: We performed a meta-analysis of 16 studies that assessed the effectiveness of probiotics administered concurrently with antibiotics compared to the use of antibiotics alone. The use of probiotics among patients in these trials reduced the risk of antibiotic-associated diarrhea by almost 40% and decreased the rate of Clostridium difficile infection by 63%. On subgroup analysis, the reduction remained statistically significant for the subgroups of good quality trials, trials in which a primarily Lactobacillus-based regimen was used, and those studies which had a follow-up period of less than 4 weeks.
MedicalResearch.com: Were any of the findings unexpected?
Dr. Pattani: The effectiveness of probiotics has a physiologic basis; they are thought to repopulate the digestive tract with healthy bacteria which can keep aggressive pathogens like C. difficile at bay, they help promote gut wall integrity, and they strengthen the immune system. As such, these findings were not surprising.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Pattani: On the basis of these findings, we hope that clinicians will consider prescribing probiotics for their adult patients admitted to hospital who are receiving antibiotics as part of their management, if there are no contraindications.
For individual patients, we encourage them to speak with their doctor about the possible benefits of probiotics if they are hospitalized and receiving antibiotics; this intervention should be undertaken in consultation with a physician.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Pattani: A large study, enrolling thousands of patients, in a population with lower, more representative, baseline rates of C. difficile, may compel hospital administrators to implement the use of probiotics as a hospital-wide intervention. Furthermore, whether a single-species or combination formulation is more effective needs to be determined. Finally, the hypothesis of a dose-response effect, as demonstrated in one of the recent trials (Gao et al, Am J Gastroenterol 2010) requires validation.
Probiotics for the prevention of antibiotic-associated diarrhea and Clostridium difficile infection among hospitalized patients: systematic review and meta-analysis
PATTANI, R., PALDA, V., HWANG, S., SHAH, P.. Probiotics for the prevention of antibiotic-associated diarrhea and Clostridium difficile infection among hospitalized patients: systematic review and meta-analysis.
Open Medicine, North America, 7, jun. 2013.
Available at: http://www.openmedicine.ca/article/view/597/502