Probiotics fail to prevent antibiotic-associated, C. difficile diarrhea in elderly
A multistrain preparation of lactobacilli and bifidobacteria failed to prevent antibiotic-associated diarrhea and/or Clostridium difficile diarrhea in elderly patients, a new study found.
A multistrain preparation of lactobacilli and bifidobacteria failed to prevent antibiotic-associated diarrhea and/or Clostridium difficile diarrhea in elderly patients, a new study found.
In a randomized, double-blind, placebo-controlled trial, researchers assigned inpatients to receive either placebo or the multistrain preparation with a total of 6 × 1010 organisms, one per day for 21 days. The inpatients came from five U.K. facilities and were at least 65 years old. They had been exposed to one or more oral or intravenous antibiotics in the previous seven days or were about to start antibiotics.
The trial's main outcomes were occurrence of antibiotic-associated diarrhea (AAD) within eight weeks and C. difficile diarrhea (CDD) within 12 weeks of recruitment. Results were published online Aug. 8 by The Lancet.
AAD (including CDD) occurred in 10.8% of the inpatients in the microbial preparation group (n=1,470) and 10.4% of the inpatients in the placebo group (n=1,471); the difference was not significant between groups. CDD was an uncommon cause of AAD and occurred in 12 (0.8%) inpatients in the microbial preparation group and 17 (1.2%) inpatients in the placebo group. About 20% of participants had one or more serious adverse events, and the frequency of these events didn't differ by group, nor were they attributed to study factors. An analysis of secondary outcomes including diarrhea severity, length of hospital stay, frequency of abdominal symptoms and quality of life also showed no benefit for probiotics.
This trial indicates there is insufficient evidence to support routinely using probiotics to prevent AAD in older inpatients, the authors wrote. The prospects for future studies are hampered by a poor understanding of the pathophysiology of AAD, they added. Future trials should be done only “when there is supporting evidence that one or more specific microbes act against identified underlying pathophysiological mechanisms for AAD and CDD in a specific population group,” they wrote.