Probiotics as adjunctive therapy for preventing Clostridium difficile infection – What are we waiting for?

Abstract

With the end of the golden era of antibiotic discovery, the emergence of a new post-antibiotic age threatens to thrust global health and modern medicine back to the pre-antibiotic era. Antibiotic overuse has resulted in the natural evolution and selection of multi-drug resistant bacteria. One major public health threat, Clostridium difficile, is now the single leading cause of hospital-acquired bacterial infections and is by far the most deadly enteric pathogen for the U.S. population. Due to the high morbidity and mortality and increasing incidence that coincides with antibiotic use, non-traditional therapeutics are ideal alternatives to current treatment methods and also provide an avenue towards prevention. Despite the need for alternative therapies to antibiotics and the safety of most probiotics on the market, researchers are inundated with regulatory issues that hinder the translational science required to push these therapies forward. This review discusses the regulatory challenges of probiotic research, expert opinion regarding the application of probiotics to C. difficile infection and the efficacy of probiotics in preventing this disease.

Biofilm Forming Lactobacillus: New Challenges for the Development of Probiotics

“…Non-traditional therapies also constitute a preventive course of action. Nevertheless, experts sustain that it is necessary to pursue efforts to determine specific probiotic doses and formulations by high quality clinical studies in order to elucidate clear recommendations for probiotic applications that will favor health [ 34 ]. Probiotics can also act outside the gastrointestinal system.…”

Next-Generation Probiotics Targeting Clostridium difficile through Precursor-Directed Antimicrobial Biosynthesis

“…Some promising adjunct therapies include the supplementation of staggered antibiotic withdrawal with Lifeway kefir in recurrent CDI cases (11) or the coadministration of Bio-Kϩ with antibiotics to decrease the incidence of primary CDI (12,13). In the United States, adjunct therapy is not yet recommended by the Society for Healthcare Epidemiology of America or the Infectious Diseases Society of America, despite a growing body of evidence in the literature supporting probiotic use for CDI prevention (14)(15)(16). Nevertheless, next-generation probiotics are actively being investigated for use in CDI prevention (17).…”

The Role of the Microbiota in the Prevention of Hospital Infections

“…Sağlıklı bir gastrointestinal mikrobiyotada antibiyotikler nedeniyle meydana gelen bozulmalar, infeksiyon duyarlılığını artırır. Yardımcı probiyotik tedavi, gastrointestinal mikrobiyotayı stabilize ederek, çeşitli mekanizmalarla konakçıyı koruyarak ve patojen istilasını önleyerek infeksiyonlara karşı koruma sağlar (Şekil 2) [27] . Genelde C. difficile infeksiyonunu (CDI) ve ishali önlemek ve genel insan sağlığını geliştirmek için probiyotik kullanımı üzerine her yıl artan bir ilgi vardır.…”

“…Bu numuneler daha sonra, bu hastanın mikrobiyotasının yeniden implantasyo-Şekil 2. Gastrointestinal mikrobiyotada antibiyotikler nedeniyle meydana gelen bozulmaların yardımcı probiyotiklerle onarılması [27] . [6] .…”