Authors' objectives:

The aim of this study was to evaluate the evidence in favour of the use of probiotics for prevention and treatment of clostridium difficile-associated diarrhea (CDAD) in adults.

Authors' results and conclusions: Prevention: We identified only one randomized trial of the probiotic Lactobacillus acidphilus for prevention of CDAD. This study found a slightly lower number of C. difficile toxin positive cases in the intervention group, but the small numbers (2 cases in the intervention and 5 in the control group) preclude any conclusion. Five related studies of different probiotics, while focusing on the prevention of antibiotic-associated diarrhea (AAD) as the primary outcome (not CDAD), included some cases of C. difficile. The small numbers of CDAD cases in these studies limit conclusions but did not provide any suggestion of benefit. Treatment: Of the 3 randomized studies of the use of probiotics for the treatment of CDAD, one study using the probiotic L. plantarum 299v was inconclusive due to a very small sample size (21 patients). The other two studies evaluated the probiotic yeast S. boulardii and the overall results were inconclusive. Each reported a beneficial effect in a sub-group of patients one in those with a history of CDAD, and the other in those subjects using high-doses of vancomycin but such weak evidence can only be interpreted as hypothesis generating. Safety: Probiotics seem to have good safety profile, though there have been some case reports of fungemia and bacterimia, particularly among immunocompromised patients.

Authors' recommendations: There is very little evidence relating to the use of probiotics for either prevention or treatment of CDAD. Available evidence does not support the administration of probiotics with antibiotics to prevent the development of CDAD, and is inadequate to justify its introduction as a treatment for developed CDAD at the MUHC. The suggestive, but as yet inconclusive, evidence of benefit with probiotics in the treatment of AAD suggests direction for future studies.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.mcgill.ca/tau/publications/2005/

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Technology Assessment Unit of the McGill University Health Centre (MUHC)

Contact Address: Technology Assessment Unit of the MUHC, 536-5100 Boul. Maisonneuve O, Montreal, H4A 3T2

Contact Name: eva.suarthana@mcgill.ca

Contact Email: nisha.almeida@muhc.mcgill.ca

Copyright: Technology Assessment Unit of the McGill University Health Centre (MUHC)