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Probiotics reduce C. difficile infection risk in hospitalized patients taking antibiotics

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The use of probiotics significantly reduced the risk for Clostridium difficile infection in hospitalized patients who already were assigned antibiotics, according to data presented at Digestive Disease Week 2016.

“The available evidence strongly suggests the use of probiotics significantly reduces the risk of [Clostridium difficile infection] in hospitalized patients taking antibiotics and that further studies are not needed to establish efficacy,” Nicole T. Shen, in the department of internal medicine at NewYork-Presbyterian, and colleagues wrote. “However, further studies are needed to identify optimal dose and strains.”

In previous studies, probiotics efficacy has been strongly suggested, according to the researchers. With the recent PLACIDE randomized controlled trial on probiotics completed, Shen and colleagues sought to incorporate these data into an updated systematic review.

The researchers reviewed randomized control trials of hospitalized adults assigned antibiotics and a probiotic; the primary outcome was efficacy of probiotics in preventing C. difficile infection. They analyzed 19 studies that included 6,942 participants, and they determined that C. difficile infection incidence was smaller in the probiotic group compared with the placebo group (1.5% vs. 3.5%; P = .005).

Overall, probiotics showed efficacy in treating C. difficile infection (RR = 0.41; 95% CI, 0.30-0.57). In prespecified subgroup analysis, timing of the probiotic in relationship to first antibiotic dose was significant, with a RR of 0.32 (95% CI, 0.21-0.47) and RR of 0.70 (95% CI, 0.40-1.23) for probiotics respectively given within 2 and 7 days of the first antibiotic dose (P = 0.02). In addition, there was no difference in using milk vs. capsule as formulation.

“C. difficile infection is a billion dollar problem with significant morbidity and mortality,” Shen and colleagues wrote. “Prevention in those at high risk of infection is essential.” – by Will Offit

Reference:

Shen NT, et al. Abstract 661. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego.

Disclosure: Shen reports no relevant financial disclosures.