Effect of Probiotic Use on Antibiotic Administration Among Care Home Residents

Abstract

Question Does a dose of a daily oral probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis BB-12 reduce cumulative systemic antibiotic administration days for all-cause, acute infections in care home residents? Findings In this randomized clinical trial that included 310 participants, this daily probiotic combination, compared with placebo, did not significantly reduce antibiotic administration over 1 year (mean cumulative antibiotic administration days, 12.9 days vs 12.0 days). Meaning The findings do not support the use of probiotics for reducing antibiotic administration in older adults living in care homes 3

The aging gut microbiome and its impact on host immunity

“…Vaccine challenge studies routinely test the function of the adaptive immune system while not addressing consequences of an age-related decline of innate immunity in some bacterial infections. However, in the largest study conducted in 23 care homes in the United Kingdom and recently reported as the Probiotics to Reduce Infections iN CarE home reSidentS trial, LGG, and BB12 daily capsule intake for up to 1 year had no effect on the prevention of infection [ 121 ]. No difference was found regarding signs of infection, antibiotic use, hospitalization, or mortality.…”

Combination of the Probiotics Lacticaseibacillus rhamnosus GG and Bifidobacterium animalis subsp. lactis, BB-12 Has Limited Effect on Biomarkers of Immunity and Inflammation in Older People Resident in Care Homes: Results From the Probiotics to Reduce Infections iN CarE home reSidentS Randomized, Controlled Trial

“…These observations suggest that gut colonization by LGG and BB-12 is not associated with generalized improvements in immune function in older people resident in care homes. Consistent with this finding, the primary outcome of the PRINCESS trial, antibiotic use, was not reduced by probiotics ( 30 ). We also studied response to seasonal influenza vaccination in a sub-set of participants.…”

“…The PRINCESS trial was a two-arm double-blind individually-randomized placebo controlled trial, involving three academic centers in the UK (Universities of Cardiff, Oxford and Southampton). The full protocol ( 29 ) and the main outcomes ( 30 ) of the PRINCESS trial have been published. The PRINCESS trial was approved by the Wales REC 3 (15/WA/0306) and is registered as ISRCTN16392920.…”

“…The Probiotics to Reduce Infections iN CarE home reSidentS (PRINCESS) trial is a randomized, placebo-controlled trial of the combination of LGG and BB-12 in older people resident in care homes with the primary outcome being antibiotic use ( 29 ). The primary and a number of secondary outcomes of the PRINCESS trial are reported elsewhere ( 30 ). Importantly, the likelihood of colonization with both LGG and BB-12 and the number of both LGG and BB-12 present in feces were significantly higher in the group receiving LGG plus BB-12 compared to the placebo group ( 30 ).…”

“…The primary and a number of secondary outcomes of the PRINCESS trial are reported elsewhere ( 30 ). Importantly, the likelihood of colonization with both LGG and BB-12 and the number of both LGG and BB-12 present in feces were significantly higher in the group receiving LGG plus BB-12 compared to the placebo group ( 30 ). Here we report a range of immune and inflammatory markers for participants in the PRINCESS trial; we assessed static measures in blood [full blood count, immune phenotypes, plasma immune mediator and C-reactive protein (CRP) concentrations] as well as blood immune cell responses after ex vivo challenge (phagocytosis, blood culture responses to immune stimulation) and included components of both innate and acquired immunity.…”