NMA: Nonprescription Medicines Academy

Probiotic Prophylaxis Associated With a Large Reduction in Clostridium difficile Associated Diarrhea

December 14th, 2012

A systematic review and meta-analysis of 20 randomized, controlled trials testing the impact of probiotics (Bifidobacterium, Lactobacillus, Saccharomyces, or Streptococcus species) in adults and children receiving antibiotics showed a 66% reduction in the incidence of Clostridium difficile–associated diarrhea (CDAD), based on moderate-quality evidence.

The 20 trials included 3,818 participants. Probiotics were found to reduce CDAD (relative risk, 0.34; 95% CI, 0.24–0.49; I2 = 0%; heterogeneity P = 0.79). In a population with a 5% incidence of antibiotic-associated CDAD (median control group risk), probiotic prophylaxis would prevent 33 episodes (CI, 25–38 episodes) per 1,000 persons. The incidence of adverse effects was 9.3% among probiotic-treated patients and 12.6% among control patients (relative risk, 0.82; CI, 0.65–1.05; I2 = 17%).

A limitation noted by the authors was that data on CDAD were missing for 5% to 45% of patients in 13 of the trials. However, analyses that used worst-plausible assumptions regarding event rates in studies with missing outcome data still showed a large effect of probiotic prophylaxis (relative risk, 0.50; CI, 0.34–0.76; I2 = 28%; heterogeneity P = 0.13).

The authors concluded that given the low cost and apparent safety of probiotics, there seems little reason not to encourage their use by patients receiving antibiotics who are at appreciable risk for CDAD.

Ann Intern Med. 2012 Nov 13. [Epub ahead of print]