scholarly journals Potion or Poison? Probiotics

2013 ◽  
Vol 5 (1) ◽  
pp. 81 ◽  
Author(s):  
Shane Scahill
Keyword(s):  
Clostridium Difficile ◽  
Antibiotic Therapy ◽  
Clinical Benefit ◽  
Lactobacillus Rhamnosus ◽  
Saccharomyces Boulardii ◽  
Insufficient Evidence ◽  
Probiotic Lactobacillus ◽  
High Doses ◽  
Antibiotic Associated Diarrhoea

SUMMARY MESSAGE: Two types of probiotic (Lactobacillus rhamnosus and Saccharomyces boulardii) at high doses may prevent the onset of antibiotic-associated diarrhoea in children. Probiotics are generally well tolerated. Clinical benefit needs to be confirmed in larger studies across a greater range of probiotics. There is insufficient evidence to recommend probiotic therapy in adults as an adjunct to antibiotic therapy, specifically for Clostridium difficile-induced colitis.

Deciphering meta-analytic results: a mini-review of probiotics for the prevention of paediatric antibiotic-associated diarrhoea and Clostridium difficile infections

2015 ◽  
Vol 6 (2) ◽  
pp. 189-194 ◽  
Author(s):  
L.V. McFarland
Keyword(s):  
Clostridium Difficile ◽  
Protective Efficacy ◽  
Meta Analysis ◽  
Lactobacillus Rhamnosus ◽  
Saccharomyces Boulardii ◽  
Clinical Practices ◽  
Therapeutic Decisions ◽  
Different Types ◽  
Meta Analyses ◽  
Antibiotic Associated Diarrhoea

Meta-analyses are used to evaluate pooled effects of a wide variety of investigational agents, but the interpretation of the results into clinical practices may be difficult. This mini-review offers a three-step process to enable healthcare providers to decipher pooled meta-analysis estimates into results that are useful for therapeutic decisions. As an example of how meta-analyses should be interpreted, a recent meta-analysis of probiotics for the prevention of paediatric antibiotic-associated diarrhoea (AAD) and the prevention of Clostridium difficile infections (CDI) will be used. First, the pooled results of this meta-analysis indicates a significant protective efficacy for AAD is found when the 16 different types of probiotics are combined (pooled relative risk (RR) = 0.43, 95% confidence interval (CI)=0.33-0.56) and also a significant reduction of paediatric CDI (pooled RR=0.34, 95%CI=0.16-0.74) was found pooling four different types of probiotics. Secondly, because the efficacy of probiotics is strain-specific, it is necessary to do a sensitivity analysis, restricting the meta-analysis to one specific strain. Two strains, Saccharomyces boulardii lyo and Lactobacillus rhamnosus GG showed significant efficacy for paediatric AAD when pooled (pooled RR for S. boulardii = 0.43, 95%CI=0.21-0.86 and pooled RR for L. rhamnosus GG = 0.44, 95%CI=0.20-0.95). Thirdly, if studies within probiotic types have different results, it is prudent to examine these studies individually to determine the reasons why non-significant differences in efficacy were found. By drilling down through these three analytic layers, physicians will be confident in recommending the correct probiotic strain to their patients.

Probiotics for Clostridium difficile–Associated Diarrhea: Focus on Lactobacillus rhamnosus GG and Saccharomyces boulardii

2007 ◽  
Vol 41 (7-8) ◽  
pp. 1212-1221 ◽  
Author(s):  
Marisel Segarra-Newnham
Keyword(s):  
Clostridium Difficile ◽  
Case Reports ◽  
Data Extraction ◽  
Meta Analysis ◽  
Lactobacillus Rhamnosus ◽  
Case Series ◽  
Saccharomyces Boulardii ◽  
First Episode ◽  
Lactobacillus Rhamnosus Gg ◽  
Clostridium Difficile Associated Diarrhea

Objective: To review the literature on the use of probiotics to treat or prevent recurrences of Clostridium difficile-associated diarrhea (CDAD) by replacing normal gastric flora. Data Sources: PubMed (1970–March 2007) was searched using the terms probiotics, Clostridium difficile, colitis, diarrhea, prevention, and treatment. Study Selection and Data Extraction: Case reports, case series, and clinical trials describing the use of probiotics in the treatment or prevention of recurrences of CDAD as primary outcome were included. Data Synthesis: A variety of controlled trials, case series, and case reports have evaluated probiotics to treat first or recurrent episodes of CDAD. In addition, a meta-analysis has been conducted to try to determine the rote of probiotics in CDAD. In general, most case series and case reports have shown favorable results with Lactobacillus rhamnosus GG or Saccharomyces boulardii. However, other reports have shown lack of benefit. The meta-analysis showed that these probiotics may be useful in treating or preventing recurrences of CDAD. Nonetheless, the heterogeneity of the studies makes definite conclusions difficult. In addition, several cases of bacteremia or fungemia associated with probiotic use have been reported, particularly in the last decade. Patients most commonly affected by these complications are immunosuppressed. Unfortunately, these are also the patients more likely to have severe CDAD or are at risk for recurrences. Conclusions: Additional experience with and study of probiotics are warranted due to numerous unanswered questions. Given the potential for complications in debilitated and immunosuppressed patients, the risks may outweigh benefits, and rational antibiotic use may be a better option to prevent a first episode or recurrence of CDAD.

scholarly journals Probióticos en diarrea aguda, asociada a antibióticos y nosocomial: evidencia en pediatría

2018 ◽  
Vol 33 (1) ◽  
pp. 41
Author(s):  
Sebastian Posada Bustos ◽  
Jose Fernando Vera Chamorro
Keyword(s):  
Clostridium Difficile ◽  
Lactobacillus Rhamnosus ◽  
Saccharomyces Boulardii ◽  
Lactobacillus Rhamnosus Gg

Introducción: Los probióticos son microorganismos vivos, que administrados en cantidades adecuadas proveen una acción benéfica en el ser humano. Existen numerosos estudios acerca de su uso en enfermedad diarreica en pediatría, por lo que se hace necesario evaluar la evidencia.Métodos: Se realizó una revisión de la literatura incluyendo solo metaanálisis y revisiones sistemáticas en los últimos diez años acerca del uso de probióticos en diarrea aguda, diarrea asociada a antibióticos y Clostridium difficile y diarrea nosocomial.Resultados: En diarrea aguda, metaanálisis muestran disminución de la duración en un día (IC 95%; 15,9 a 33,6 horas) y disminución del riesgo de prolongación en los siguientes 4 y 7 días, con recomendaciones fuertes y evidencia moderada para Lactobacillus rhamnosus GG y Saccharomyces boulardii. En diarrea asociada a antibióticos y a Clostridium difficile, los metanálisis muestran reducción del riesgo entre el 50-60%, con recomendación fuerte para Lactobacillus rhamnosus GG y Saccharomyces boulardii con un NNT de 10 (IC 95%; 7-12). En diarrea nosocomial se encontró evidencia moderada con el uso de Lactobacillus rhamnosus GG, principalmente en reducción del riesgo de gastroenteritis sintomática por rotavirus. Sin evidencia suficiente para dar recomendación para las cepas S. thermophiles y B. bifidum. Conclusión: Sólo existe evidencia con los probióticos Lactobacillus rhamnosus GG  y Saccharomyces boulardii en reducción de la duración y disminución del riesgo de prolongación de diarrea aguda, así como reducción del riesgo entre 50-60% de diarrea asociada a antibióticos. Existe evidencia moderada con Lactobacillus rhamnosus GG, en la reducción de riesgo de diarrea nosocomial.

Preventing antibiotic associated diarrhoea using a probiotic Lactobacillus Casei preparation

2009 ◽  
Vol 47 (05) ◽  
Author(s):  
C Kamhuber ◽  
S Hörist-Kollmann ◽  
A Rek ◽  
G Eckhardt ◽  
A Zauner ◽  
...  
Keyword(s):  
Lactobacillus Casei ◽  
Probiotic Lactobacillus ◽  
Antibiotic Associated Diarrhoea
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