Probiotics For Clostridium Difficile Infection
Alan Gaby, MD
For Author: Barker AK, et al
Reference: A randomized controlled trial of probiotics for Clostridium difficile infection in adults (PICO). J Antimicrob Chemother 2017;72:3177-3180.
Design: Randomized, double-blind, placebo-controlled trial.
Participants: Thirty-three patients with an initial episode of mild-to-moderate Clostridium difficile infection.
Study Medication and Dosage: One capsule per day of a 4-strain probiotic or placebo for 28 days, in addition to standard antibiotic treatment (vancomycin or metronidazole). The probiotic contained Lactobacillus acidophilus NCFM, L. paracasei Lpc-37, Bifidobacterium lactis Bi-07 and B. lactis Bl-04 (1.7 x 1010 total colony-forming units per capsule).
Primary Outcome Measure: Duration of diarrhea.
Key Findings: The median number of days with diarrhea was significantly lower in the probiotic group than in the placebo group (3.5 vs. 12.0; p = 0.005).
Practice Implications: Clostridium difficile is a Gram-positive bacterium that is a common cause of antibiotic-associated diarrhea and pseudomembranous colitis. C. difficile infection usually manifests as mild-to-moderate diarrhea, but severe colitis culminating in colectomy or death may also occur. Since around the year 2000, there has been a marked increase in the incidence of C. difficile infection. Increases in disease severity and mortality rates have also been observed, apparently because of the emergence of a more virulent strain of the organism. Treatment with vancomycin or metronidazole is usually effective, but the infection recurs in approximately 20% of patients after treatment with these antibiotics. Several double-blind trials have found that administration of various probiotic organisms can prevent the development or reduce the recurrence rate of C. difficile infection. The present study demonstrates that probiotics can also be used as an adjunct to antibiotic therapy to accelerate recovery from C. difficile-associated diarrhea.
Gaby AR. Clostridium difficile. In Gaby AR. Nutritional Medicine, Second Edition. Concord, NH, 2017, www.doctorgaby.com; chapter 310.