Lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and Clostridium difficile diarrhoea in older inpatients (PLACIDE): a randomised, double-blind, placebo-controlled, multicentre trial

Allen, SJ; Wareham, K.; Wang, Duolao; Bradley, Caroline; Hutchings, Hayley; Harris, Wilfred; Dhar, Anjan; Brown, Helga; Foden, A; Gravenor, Michael B.; Mack, Dietrich

doi:10.1016/s0140-6736(13)61218-0

Cited by 331 publications

(281 citation statements)

References 30 publications

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“…Yet, these results, combined with those of another study3 that identified a negative impact of probiotics in neonatal foals raise concerns. Selected probiotics have been shown to be effective for some gastrointestinal disorders in humans and domestic animals yet prevention of neonatal diarrhea has not been reported 27, 28. Further, successful probiotic studies have often involved inflammatory, not infectious, disorders,29, 30 raising questions of the potential efficacy of probiotics in foals given the pathophysiology of foal diarrhea.…”

Section: Discussionmentioning

confidence: 99%

Effect of a Probiotic on Prevention of Diarrhea and Clostridium difficile and Clostridium perfringens Shedding in Foals

Schoster

Staempfli

Abrahams

et al. 2015

Veterinary Internal Medicne

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BackgroundUp to 60% of foals develop diarrhea within 6 months after birth. Preventive measures are limited but potentially probiotics could be used.ObjectiveTo evaluate the effect of a newly designed probiotic on the incidence of foal diarrhea in a randomized field trial.AnimalsSeventy‐two healthy neonatal foals.MethodsRandomized, placebo‐controlled field trial. Foals were administered a placebo or probiotic for 3 weeks and monitored for an additional week. A total of 3 fecal samples were taken from each foal at biweekly intervals. Statistical modeling was applied for comparison of incidence and duration of diarrhea and fecal shedding of Clostridium perfringens and Clostridium difficile between treatment and age groups.ResultsThe overall incidence of diarrhea was 41 of 72 (59%) and did not differ (P = 0.37) between treatment groups. Foals treated with probiotics were more likely to develop diarrhea requiring veterinary intervention (P = 0.007). Age had a significant effect on incidence of diarrhea (P < 0.001); foals 8–15 days old having the highest probability of developing diarrhea. Duration of diarrhea and soft feces were not significantly different between groups. The prevalence of C. perfringens shedding was 55% with no difference between treatment groups (P = 0.23). The prevalence of C. difficile shedding was 11%.Conclusion and Clinical ImportanceThere was no benefit of administering a 3‐week course of probiotics, but potential adverse effects were noted. Whether the probiotics lacked a clinical effect, or the choice of strains or dose was inadequate, is unknown. Clostridial shedding was not influenced by probiotics despite in vitro activity of probiotics.

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Section: Discussionmentioning

confidence: 99%

Effect of a Probiotic on Prevention of Diarrhea and Clostridium difficile and Clostridium perfringens Shedding in Foals

Schoster

Staempfli

Abrahams

et al. 2015

Veterinary Internal Medicne

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“…Using the mean baseline risk of 3.8%, the RR of 0.39 corresponds to an ARR of 2.3% and an NNT of 43. Using the same RR of 0.39, based on the control group of the largest RCT to date (n 5 1,488), the baseline risk of 1.2% corresponds to an ARR of 0.73% and an NNT of 137 [17]. In a second example drawn from an actual abstract: ''patients randomized to primary percutaneous coronary intervention (PPCI) had lower mortality than did patients randomized to fibrinolysis (5.3% vs 7.9%, adjusted odds ratio 0.63, 95% CI 0.42-0.84, P !…”

Section: Implications and Future Directionsmentioning

confidence: 99%

Authors seldom report the most patient-important outcomes and absolute effect measures in systematic review abstracts

Agarwal

Johnston

Vernooij

et al. 2017

Journal of Clinical Epidemiology

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“…Owing to low cost and rare occurrence of important adverse effects, probiotics are frequently prescribed and utilized by patients, especially for patients who received high-risk antibiotics [7]. To our knowledge, this is the first study designed to evaluate the role of probiotics in primary CDI prophylaxis for patients receiving antibiotics with an increased risk of CDI.…”

Section: Discussionmentioning

confidence: 99%

“…Administering probiotics concomitantly with antibiotic treatment has been considered as a potential strategy for preventing CDI. There have been a variety of studies that investigated the potential benefits of using probiotics for either primary or secondary CDI prophylaxis; however, the findings were inconclusive [6,7]. According to the Clinical Practice Guidelines for CDI in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA), the administration of probiotics is not recommended for the prevention of primary CDI due to limited data and conflicting results.…”

Section: Introductionmentioning

confidence: 99%

Clinical Impact of Probiotics among Patients Receiving Antibiotics with a High Risk of Acquiring Clostridium difficile Infection

Dickson¹,

Hung²,

Chen³

2016

Int J Dig Dis

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Importance: Despite recommendations not to routinely use probiotics for primary prevention of Clostridium difficile infection (CDI) from Updated Practice Guidelines for CDI in 2010 by the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America, the use of probiotics remains common among prescribers and patients. To our knowledge, there has been no analysis conducted to evaluate the impact of probiotics on the primary prevention of CDI among patients receiving antibiotics known to be associated with an increased risk of CDI. Objective:To determine whether patients who receive "high-risk" antibiotics along with probiotics are at a decreased risk of developing CDI. Design, setting, and participants:This was a retrospective cohort study including adult patients admitted to Yale New Haven Hospital, Saint Raphael Campus, between July 1, 2010 and December 31, 2010. Patients were excluded if they did not receive high-risk antibiotic(s) for more than 5 days nor had a history of CDI. Interventions:Eligible patients were then analyzed based on whether they had received concomitant use of probiotics or antibiotics alone. Main outcome(s) and measure(s):The primary outcome of the study was the development of CDI within 90 days of high-risk antibiotic use.Results: A total of 389 patients were included in the study. CDI occurred in 8.4% (12/143) of patients who received concomitant probiotics as opposed to 3.3% (8/246) that had CDI and received antibiotics alone with relative risk (RR) of 2.58 (95% CI: 1.08, 6.16; p=0.033). A chi-square analysis identified statistically significant differences in age (p<0.0001) and proton-pump inhibitor (PPI) utilization (p=0.0088), but the imbalance between patients with and without probiotics was removed after adjusting for the propensity score (p=0.1141). Conclusion and relevance:We found that use of antibiotics along with probiotics had a significantly higher incidence of CDI than those who did not receive probiotics. Our findings based on adjusted odds ratio do not support the recommendation of the routine use of probiotics for the prevention of CDI. Other strategies such as eliminating the unnecessary use of PPI should be applied to prevent CDI.

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Lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and Clostridium difficile diarrhoea in older inpatients (PLACIDE): a randomised, double-blind, placebo-controlled, multicentre trial

Abstract: Health Technology Assessment programme; National Institute for Health Research, UK.

Cited by 331 publications

References 30 publications

Effect of a Probiotic on Prevention of Diarrhea and Clostridium difficile and Clostridium perfringens Shedding in Foals

Effect of a Probiotic on Prevention of Diarrhea and Clostridium difficile and Clostridium perfringens Shedding in Foals

Authors seldom report the most patient-important outcomes and absolute effect measures in systematic review abstracts

Clinical Impact of Probiotics among Patients Receiving Antibiotics with a High Risk of Acquiring Clostridium difficile Infection

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