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Are probiotics useful for preventing and treating C difficile diarrhoea?

Can probiotics be used to prevent and treat Clostridium difficile-associated diarrhoea?

UK Medicines Information

Clostridium difficile infection can occur following treatment with antibiotics that disrupt the normal microflora of the gastrointestinal tract, allowing colonisation of the pathogen. Probiotics are micro-organisms intended to have health benefits when consumed.

Probiotics consist of non-pathogenic yeast or bacteria and are found in cultured and fermented foods including yoghurt, buttermilk and cheese. Probiotic yoghurt drinks marketed for their “friendly bacteria” content and probiotic tablets and capsules are widely available. It has been suggested that probiotics may be useful for preventing and treating C difficile-associated diarrhoea (CDAD) by helping to maintain or re-establish normal gut flora.

Recently published meta-analyses conclude there is evidence that probiotics prevent CDAD in people taking antibiotics, without an increase in clinically important adverse events. Patients given probiotics are about 66% less likely to develop CDAD compared with those given placebo or no treatment. The evidence is of moderate quality but consistently shows that probiotics prevent CDAD and are safe.

Most of the trials tested probiotics in adults taking a variety of antibiotics for acute infections. Probiotic preparations included Bifidobacterium, Lactobacillus, Saccharomyces and Streptococcus species, alone or in combination. Patients took probiotics for the duration of their antibiotic treatment and for up to two weeks after.

Patients who were immunosuppressed or severely debilitated were excluded from most studies; therefore, the safety of probiotics in such patients is unknown and they should not be given probiotics.

There is insufficient evidence to support use of probiotics for treatment of CDAD.

This FAQ is taken from a “Medicines Q&A” produced by UK Medicines Information. The full document, including references, is available from www.evidence.nhs.uk (prepared March 2013). NHS Evidence is provided by the National Institute for Health and Care Excellence and incorporates content formerly held in the National electronic Library for Medicines

Citation: Clinical Pharmacist DOI: 10.1211/CP.2013.11121705

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