Probiotics for the Prevention of Clostridium difficile–Associated Diarrhea

  title={Probiotics for the Prevention of Clostridium difficile–Associated Diarrhea},
  author={Bradley C Johnston and Stephanie S.Y. Ma and Joshua Z. Goldenberg and Kristian Thorlund and Per Olav Vandvik and Mark Loeb and Gordon H. Guyatt},
  journal={Annals of Internal Medicine},
  pages={878 - 888}
BACKGROUND Antibiotic treatment may disturb the resistance of gastrointestinal flora to colonization. This may result in complications, the most serious of which is Clostridium difficile–associated diarrhea (CDAD). PURPOSE To assess the efficacy and safety of probiotics for the prevention of CDAD in adults and children receiving antibiotics. DATA SOURCES Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, Allied and Complementary Medicine Database, Web of Science, and… 
Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children.
The overall evidence warrants moderate confidence in this large relative risk reduction of C. difficile infection in adults and children, and the overall quality of evidence for CDAD is downgraded to 'moderate' due to imprecision.
Probiotics are effective at preventing Clostridium difficile-associated diarrhea: a systematic review and meta-analysis
Introduction Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated diarrhea. CDI has increased in incidence and severity over the past decade, and is a growing worldwide
Timely Use of Probiotics in Hospitalized Adults Prevents Clostridium difficile Infection: A Systematic Review With Meta-Regression Analysis.
Evidence is found that administration of probiotics closer to the first dose of antibiotic reduces the risk of CDI by >50% in hospitalized adults and future research should focus on optimal probiotic dose, species, and formulation.
Probiotics for the Prevention of Antibiotic-associated Diarrhea in Adults
Using probiotics as early as possible during antibiotic therapy has a positive and safe effect on preventing AAD in adults, and further studies should focus on the optimal dosage and duration of probiotics to develop a specific recommendation.
Probiotics and Fecal Microbiota Transplant for Primary and Secondary Prevention of Clostridium difficile Infection
Probiotics have been proposed as a method for restoring gut microbiota and has been shown to significantly increase the rate of cure in patients with recurrent CDI, and guideline recommendations for the use of these agents in the primary and secondary prevention of CDI are summarized.
Efficacy of Lactobacillus rhamnosus GG in treatment of acute pediatric diarrhea: A systematic review with meta-analysis
High-dose LGG therapy reduces the duration of diarrhea and the stool number per day and intervention at the early stage is recommended.
Clinical Impact of Probiotics among Patients Receiving Antibiotics with a High Risk of Acquiring Clostridium difficile Infection
Findings based on adjusted odds ratio do not support the recommendation of the routine use of probiotics for the prevention of CDI and other strategies such as eliminating the unnecessary use of PPI should be applied to prevent CDI.
Probiotics for prevention of radiation-induced diarrhea: A meta-analysis of randomized controlled trials
Background Radiotherapy is commonly used for abdominal or pelvic cancer, and patients receiving radiotherapy have a high risk developing to an acute radiation-induced diarrhea. Several previous
Clostridium difficile: biological therapies
Biological therapies for CDI, especially FMT, will continue to attract attention, and large-scale RCTs are required to identify which patients are most likely to benefit from these therapies in the future.
Efficacy of oral vancomycin prophylaxis for prevention of Clostridioides difficile infection: a systematic review and meta-analysis
OVP appears to decrease the risk of future CDI in patients with prior CDI who require systemic antimicrobial therapy, however, OVP was not effective for primary prevention of CDI.


Probiotics for the prevention of pediatric antibiotic-associated diarrhea.
The current data are promising, but it is premature to routinely recommend probiotics for the prevention of pediatric AAD, as per protocol analysis yields treatment effect estimates that are both statistically and clinically significant.
Probiotic therapy for the prevention and treatment of Clostridium difficile-associated diarrhea: a systematic review
A systematic review of randomized controlled trials for the effectiveness of probiotic therapy found insufficient evidence for the routine clinical use of probiotics to prevent or treat CDAD.
Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis.
The pooled evidence suggests that probiotics are associated with a reduction in AAD, and there exists significant heterogeneity in pooled results and the evidence is insufficient to determine whether this association varies systematically by population, antibiotic characteristic, or probiotic preparation.
Clostridium difficile pilot study: effects of probiotic supplementation on the incidence of C. difficile diarrhoea.
The role of probiotic administration in the prevention of C. difficile-associated diarrhoea in elderly patients receiving antibiotic therapy is examined in a double-blind, placebo-controlled study.
The mechanisms and efficacy of probiotics in the prevention of Clostridium difficile-associated diarrhoea.
Prophylactic Lactobacillus GGReduces Antibiotic-Associated Diarrhea in Children With Respiratory Infections: A Randomized Study
The incidence of diarrhea after antimicrobial treatment in children with no history of antimicrobial use during the previous 3 months was evaluated and the preventive potential of Lactobacillus rhamnosus GG, a probiotic strain with a documented safety record, was assessed.
[Effect of probiotic Saccharomyces boulardii on prevention of antibiotic-associated diarrhea in adult outpatients with amoxicillin treatment].
Saccharomyces boulardii (500 mg/day) did not prevent diarrhea related to amoxicillin, and no adverse effects were associated to the use of the probiotic.
VSL#3 for the prevention of antibiotic associated diarrhoea (AAD) and clostridium difficile associated diarrhoea (CDAD): an interim analysis
The incidences of both AAD and CDAD are much lower than previously reported, and updated power calculations based on the lower incidences find that the original sample size is still suitable to confirm or refute the primary hypothesis.
Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea in children: a randomized double-blind placebo-controlled trial.
This is the first randomized-controlled trial evidence that S. boulardii effectively reduces the risk of antibiotic-associated diarrhoea in children.
Lack of effect of Lactobacillus GG on antibiotic-associated diarrhea: a randomized, placebo-controlled trial.
Lactobacillus GG in a dose of 20 x 10(9) CFU/d did not reduce the rate of occurrence of diarrhea in this sample of 267 adult patients taking antibiotics initially administered in the hospital setting.