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The fascination with probiotics for Clostridium difficile infection: lack of evidence for prophylactic or therapeutic efficacy.

Anaerobe. 2009 Dec;15(6):281-4

Authors: Miller M

BACKGROUND: The association of Clostridium difficile infection (CDI) with antecedent antibiotic use suggests that perturbation of normal intestinal flora is an important inciting factor. Therefore, the use of probiotics for the prevention and/or therapy of CDI is considered to be theoretically effective. METHODS: A non-systematic review of the literature evaluating the prophylactic and therapeutic efficacy of oral bacterial or yeast products for CDI, as well as the “quality control” and deleterious effects of these agents. RESULTS: There is no convincing literature which supports the use of bacterial/yeast products to prevent CDI. There is one prophylactic study from the United Kingdom which showed efficacy, but it has been widely criticized as flawed or not generalizable. One other small case-series described the efficacy of Saccharomyces boulardii in preventing CDI relapse, but only in a subset of patients. Many bacterial/yeast products do not contain what they are purported to contain, and may contain other bacterial/fungal constituents not listed on the label. S. boulardii preparations may predispose to bloodstream infections in recipients, and have been associated with fungemia in contiguous patients when prepared at the bedside in intensive care settings. CONCLUSIONS: There is no persuasive evidence to support the use of bacterial/yeast products for the prevention or treatment of CDI. Oral preparations may not contain what is indicated on the label. Widespread use of some products may lead to bloodstream infections in susceptible individuals, and careless use of S. boulardii in an intensive care setting may place other patients at risk. At the present time, oral bacterial/yeast products do not have a role in the prevention or therapy of CDI.

PMID: 19699309 [PubMed - indexed for MEDLINE]

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Evidence-based review of probiotics for antibiotic-associated diarrhea and Clostridium difficile infections.

Anaerobe. 2009 Dec;15(6):274-80

Authors: McFarland LV

Probiotics are living microbes taken to confer a health benefit on the host. Although probiotics have a long history of use in Europe and Asia and have been on the U.S. market for over 14 years, there is still confusion about how to effectively use them. The use of probiotics for the prevention of antibiotic-associated diarrhea (AAD) and the treatment of Clostridium difficile infections (CDI) has been tested in randomized controlled clinical trials. This paper will review the evidence supporting probiotic therapy for these two diseases and also review the advantages and disadvantages of probiotics. The advantages of probiotic therapy include multiple mechanisms of action against pathogens, the ability to interact with the host’s natural defense systems, survival to the target organ and a good risk to benefit ratio. Disadvantages of probiotics include lack of standardization for clinical trial designs, variations in regulatory standards, poor quality control for some products and infrequent serious adverse reactions. Overall, probiotics offer a promising strategy for the prevention and treatment for AAD and CDI.

PMID: 19825425 [PubMed - indexed for MEDLINE]

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