May 16, 2012

Probiotics Effective Against Antibiotic-Induced Diarrhea

Chicago, ILHow to control antibiotic-induced diarrhea is a concern for patients and a common question for pharmacists. Now, you have some evidence-based advice to offer on using probiotics to control the unpleasant side-effects.

A review and meta-analysis of previous studies published this month in the Journal of the American Medical Association finds that consumption of probiotics is associated with a reduced risk of antibiotic-associated diarrhea.

Probiotics are live organisms that occur naturally in foods such as yogurt. They are thought to maintain or restore gut microbial ecology during or after antibiotic treatment.

"The use of antibiotics that disturb the gastrointestinal flora [microbes] is associated with clinical symptoms such as diarrhea, which occurs in as many as 30% of patients. Symptoms range from mild and self-limiting to severe, particularly in Clostridium difficile infections, and antibiotic-associated diarrhea (AAD) is an important reason for non-adherence with antibiotic treatment," according to background information in the article.
For the article, reviewers lead by Susanne Hempel, PhD, of RAND Health in Santa Monica, California, searched databases to identify randomized controlled trials involving AAD and probiotics such as Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and/or Bacillus. They found 82 trials that met inclusion criteria, with most using Lactobacillus-based interventions alone or in combination with other genera, although strains were poorly documented.

Together, the trials, which involved a total of 11,811 participants, indicated a 42% lower risk of diarrhea development with probiotic use compared to a control group that did not take probiotics.

Researchers caution that, because the studies differed so much, it is not yet known if the association varies by population, antibiotic characteristic, or probiotic preparation.
"In summary, our review found sufficient evidence to conclude that adjunct probiotic administration is associated with a reduced risk of AAD," the authors conclude. "This generalized conclusion likely obscures heterogeneity in effectiveness among the patients, the antibiotics, and the probiotic strains or blends. Future studies should assess these factors and explicitly assess the possibility of adverse events to better refine our understanding of the use of probiotics to prevent AAD."

With evidence that probiotics can help control AAD, patients may need help in selecting a safe and effective formulation. Manufactured probiotic products are identified by their genus (Bifidobacterium or Lactobacillus, for instance) species (longum or infantis), and strain, usually indicated by a combination of numbers and letters. Some strains are trademarked.

In addition, the International Scientific Association for Probiotics and Prebiotics recommends that probiotic packaging should detail which strain is contained and at what quantity as well as provide recommended serving size, best storage conditions, and the possible health benefit associated with the probiotic.

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