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Probiotics recommendations do little to reduce antibiotic prescribing among patients with asthma

There is no evidence that advising patients with asthma on the use of winter probiotics will reduce antibiotic prescribing rates, according to data published in the Annals of Family Medicine.

“Acute respiratory tract infection is the most common reason for attending primary care appointments and accounts for 80% of antibiotic prescriptions,” Timothy D.H. Smith, MBBCh, MRCGP, MSc, of Harambee Surgery, National Health Service East Lancashire, in the United Kingdom, and colleagues wrote. “A Cochrane review in 2011 found that, in randomized controlled trials of specific patient populations, probiotic prophylaxis significantly reduces both upper respiratory tract infections and antibiotic rates for these infections…. People with asthma are especially vulnerable to viral [upper respiratory tract infections], which are the most common trigger of acute asthma exacerbations and contribute substantially to the burden of unnecessary antibiotic prescriptions.”

To determine whether recommendations to take daily probiotics can reduce antibiotic prescribing rates among patients with asthma, the researchers conducted a randomized controlled study including 1,302 participants from the Ashfields Primary Care Center, a semiurban practice in the United Kingdom. Eligible participants were aged 5 years or older and had a current diagnosis of asthma.

All participants were mailed pamphlets during a 2-week period in late September 2013, together with their routine reminder to receive an annual influenza vaccination. The 650 randomly placed in the control group received a pamphlet with the standard advice regarding measures that have been known to reduce infections or asthma complications. Meanwhile, the pamphlets received by the 652 participants in the intervention group contained an additional section recommending they take 1 Lab4 probiotic capsule daily from October to the end of March. They also received three tokens, which they could exchange for 2 months of supplies at a time from the manufacturer through the internet or telephone. The primary outcome measure was the proportion of participants who were prescribed antibiotics for respiratory tract infections.

According to the researchers, there was no significant difference in the primary outcome measure, with 27.7% of those in the intervention group receiving antibiotics, compared with 26.9% in the control group (OR = 1.04; 95% CI, 0.82-1.34). Although uptake of probiotics was low, outcomes were similar among those who received probiotics (AOR = 1.08; 95% CI, 0.69-1.69, compared with control). In addition, the researchers reported no evidence an effect on respiratory tract infections or asthma exacerbations.

“Our data suggest that probiotics may not be effective for prophylaxis against [upper respiratory tract infections] and cast doubt on the reproducibility of earlier positive trials,” Smith and colleagues wrote. “There is, therefore, currently not enough evidence to recommend their use for preventing infections and antibiotic use in such at-risk populations as asthmatics.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.