Probiotics may ease C. difficile-associated diarrhea symptoms

LAS VEGAS — Potentially deadly antibiotic-associated Clostridium difficile-associated diarrhea (CDAD) affects 3 million Americans each year and is increasingly difficult to treat. Clinicians may want to consider probiotics as an alternative therapy to ease symptoms or even prevent CDAD, according to a researcher at the American Academy of Nurse Practitioners 26th Annual NP meeting.

“Europe has been using probiotics for a long time, and now we are researching it here in the United States,” Katherine Marie Sluder, DNP, FNP-BC, of the Portland Veterans Affairs (VA) Medical Center in Portland, Ore., said during a poster presentation.

Primarily a nosocomial infection, CDAD affects about 10% of patients who stay at least two days in a hospital facility. Approximately 3 million new cases are diagnosed in the United States each year with a price tag of more than $1.1 billion annually due to costs associated with readmission and extended stays.

“Judicious antibiotic use is key to preventing CDAD,” Sluder emphasized, but noted that administering oral capsule probiotics concurrent with antibiotics can help as well.

Data on the efficacy of probiotics for patients with CDAD have been limited due to difficulties enrolling adequate numbers of patients in clinical trials, and the results from existing trials have been mixed.

However, data from a recent meta-analysis published in the June issue of the Journal of the American Academy of Nurse Practitioners are encouraging, Sluder said.

Researchers from St. Peters University Hospital in New Brunswick, N.J., analyzed data from 1,220 patients in eight studies that met inclusion criteria, which included patient age older than 18 years, hospitalization and antibiotic use. All studies compared probiotics with placebo. The primary meta-anlaysis outcome was incidence of antibiotic-associated diarrhea and CDAD.

Probiotics assessed in the studies included Lactobacillus acidophilus, Lactobacillus bulgaricus, Lactobacillus casie, Lactobacillus rhamnosus, Bifidobacterium bifidum, Saccharomyces boulardii and Stretpococcus thermophilus.

Analysis results favored treatment with probiotics, according to Sluder. Among the 471 patients with CDAD included in the analysis, data indicated that probiotics had a protective effect (Mantel-Haenszel RR=0.29; 95% CI: 0.18-0.46). The relative RR for the potential of probiotics to decrease antibiotic-associated CDAD was 71% (95% CI: 0.18-0.46).

Sluder's own pilot study of Lactobacillus probiotics was inconclusive because none of the 32 enrolled patients developed CDAD, regardless of whether or not they received probiotics.

Despite these challenges, Sluder asserts that probiotics are “dirt cheap” and “far more promising” for CDAD management than traditional OTC antidiarrheal agents like milk of magnesia, of which CDAD patients “would have to drink gallons to benefit.”

As far as which probiotic is best CDAD, Sluder said, “the jury is still out.” She is currently planning a follow up study to her inconclusive Lactobacillus trial, in which she plans to enroll a larger patient cohort.

Clinicians planning to try probiotics for the prevention or treatment of CDAD should be aware that the FDA does not currently regulate probiotics and some health officials have expressed concern about manufacturing standards and whether some products contain live cultures.

Sluder reported no financial conflicts of interest.

Sluder KM. “The use of probiotics concurrently with antibiotics to prevent Clostridium difficile diarrhea.” Poster presented at: 26th Annual American Academy of Nurse Practitioners Conference, 2011: Las Vegas, Nevada. 

Avadhani A, Miley H. J Am Acad Nurse Pract. 2011; 23: 269-274.

Bryant Furlow is a medical writer and award-winning investigative healthcare journalist based in Albuquerque, New Mexico.

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