Probiotics May Prevent Antibiotic-Related Diarrhea


ORLANDO, FLA. — Daily intake of a lactobacilli-fermented milk may help prevent antibiotic-associated diarrhea in hospitalized patients, Natalie A. Fortier reported at the annual meeting of the American College of Gastroenterology.

Few of the published studies on the use of probiotics to prevent antibiotic-associated diarrhea have had a strong randomized, placebo-controlled design, said Ms. Fortier of the University of Montreal.

The daily drink, which contained 50 billion colony-forming units of live Lactobacillus acidophilus and L. casei, was associated with significantly fewer cases of antibiotic-associated diarrhea (7 of 41 patients) than was a placebo drink composed of lactoserum devoid of any microorganisms (16 of 43 patients).

Ms. Fortier and her colleagues at the university defined antibiotic-associated diarrhea as three or more liquid stools in a 24-hour period in the randomized, double-blind trial.

The researchers provided the active treatment or placebo daily to adult patients with an average age of 70 years on the 7–10 days that they were taking antibiotics and obtained follow-up from the patients for 21 days after they stopped taking antibiotics.

The patients began prophylactic treatment in the first 48 hours after starting antibiotics, which were primarily for upper respiratory tract infections.

Those with active diarrhea, GI bleeding, inflammatory bowel disease, Clostridium difficile infection in the last 3 months, a high risk of an immunocompromised state, lactose intolerance, or a regular intake of probiotics were excluded from the trial.

Diarrhea associated with C. difficile occurred less often in patients who received the active treatment (1 of 41) than in placebo patients (7 of 43), although the difference did not reach statistical significance.

Actively treated patients had a significantly shorter median length of stay in the hospital, compared with patients who received placebo (8 days vs. 10 days).

Ms. Fortier and her associates obtained their results from a multivariate analysis after controlling for risk factors for antibiotic-associated diarrhea and C. difficile-associated diarrhea as well for the fact that significantly more placebo patients received β-lactam antibiotics (67%) than did actively treated patients (41%).

Side effects—mostly of a GI nature—occurred in nearly half of patients in each group, she said.

The active and placebo preparations were provided by Bio-K+ International Inc., Laval, Que., which manufactures and markets the active treatment.

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