Probiotics for recurrent Clostridium difficile disease

Lawrence, Steven J.; Korzenik, Joshua R.; Mundy, Linda M.

doi:10.1099/jmm.0.46096-0

Cited by 89 publications

(41 citation statements)

References 10 publications

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“…A small trial of Lactobacillus plantarum 299v combined with metronidazole had recurrence rates of 35 % compared with 66 % in the control groups, a diff erence that was not statistically signifi cant ( 106 ). Two small RCTs of Lactobacillus rhamnosus GG failed to show effi cacy in treating RCDI ( 107,108 ). One uncontrolled study using Kefi r (an over-the-counter probiotic drink) as an adjunct to antibiotics did result in decreased recurrence of C. diffi cile ( 109 ).…”

Section: Management Of CDI and Co-morbid Conditionsmentioning

confidence: 99%

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,467

1,408

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Clostridium diffi cile infection (CDI) is a leading cause of hospital-associated gastrointestinal illness and places a high burden on our health-care system. Patients with CDI typically have extended lengths-of-stay in hospitals, and CDI is a frequent cause of large hospital outbreaks of disease. This guideline provides recommendations for the diagnosis and management of patients with CDI as well as for the prevention and control of outbreaks while supplementing previously published guidelines. New molecular diagnostic stool tests will likely replace current enzyme immunoassay tests. We suggest treatment of patients be stratifi ed depending on whether they have mild-to-moderate, severe, or complicated disease. Therapy with metronidazole remains the choice for mildto-moderate disease but may not be adequate for patients with severe or complicated disease. We propose a classifi cation of disease severity to guide therapy that is useful for clinicians. We review current treatment options for patients with recurrent CDI and recommendations for the control and prevention of outbreaks of CDI. Am J Gastroenterol 2013; 108:478-498; doi: 10.1038/ajg.2013 12. In patients in whom oral antibiotics cannot reach a segment of the colon, such as with Hartman's pouch, ileostomy, or colon diversion, vancomycin therapy delivered via enema should be added to treatments above until the patient improves. (Conditional recommendation, low-quality evidence)13. The use of anti-peristaltic agents to control diarrhea from confi rmed or suspected CDI should be limited or avoided, as they may obscure symptoms and precipitate complicated disease. Use of anti-peristaltic agents in the setting of CDI must always be accompanied by medical therapy for CDI. (Strong recommendation, low-quality evidence) Management of severe and complicated CDI14. Supportive care should be delivered to all patients and includes intravenous fl uid resuscitation, electrolyte replacement, and pharmacological venous thromboembolism prophylaxis. Furthermore, in the absence of ileus or signifi cant abdominal distention, oral or enteral feeding should be continued. 17. Vancomycin delivered orally (500 mg four times per day) and per rectum (500 mg in a volume of 500 ml four times a day) plus intravenous metronidazole (500 mg three times a day) is the treatment of choice for patients with complicated CDI with ileus or toxic colon and / or signifi cant abdominal distention. (Strong recommendation, low-quality evidence)18. Surgical consult should be obtained in all patients with complicated CDI. Surgical therapy should be considered in patients with any one of the following attributed to CDI: hypotension requiring vasopressor therapy; clinical signs of sepsis and organ dysfunction (renal and pulmonary); mental status changes; white blood cell count ≥ 50,000 cells / μ l, lactate ≥ 5 mmol / l; or failure to improve on medical therapy after 5 days. (Strong recommendation, moderate-quality evidence) Management of recurrent CDI (RCDI)19. The fi rst recurrence of CDI can be treated ...

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Section: Management Of CDI and Co-morbid Conditionsmentioning

confidence: 99%

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Surawicz

Brandt

Binion

et al. 2013

American Journal of Gastroenterology

1,467

1,408

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“…No statistically significant benefit was found with Lactobacillus plantarum or Lactobacillus rhamnosis GG in the remaining 2 studies. 47,48 Despite the limitations of probiotics in treating C. difficile infection, there is some evidence to support their value in preventing such infection. 49,50 In one meta-analysis of 22 trials (n = 3818), the incidence of C. difficile-associated diarrhea was approximately 66% lower among patients receiving probiotics than among those receiving placebo or no treatment (pooled RR 0.34, 95% CI 0.24-0.49; I 2 = 0%).…”

Section: Other Alternativesmentioning

confidence: 99%

Treatment Strategies for Recurrent Clostridium difficile Infection

Leong

Zelenitsky

2013

CJHP

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“…Probiotics may prevent attachment of C. difficile to epithelial cells and can reduce the incidence of C. difficile infection. Saccharomyces boulardii in particular has proven to be effective [49] whereas the use of Lactobacillus with conventional antibiotic therapy has shown mixed results including some studies showing no benefit in the treatment of C. difficile infection in several randomized controlled trials [85][86][87][88].…”

Section: Treatmentmentioning

confidence: 99%

Clostridium difficile in the ICU

Sherman¹,

Lewis²,

Lee³

et al. 2017

Clostridium Difficile - A Comprehensive Overview

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Clostridium difficile has become an increasingly common infectious agent in the healthcare setting. It is generally associated with antibiotic use and causes diarrhea as well as other complications such as pseudomembranous colitis (PMC) and toxic megacolon. This organism poses a serious threat to patients in the intensive care unit (ICU) as it increases hospital length of stay, morbidity, and mortality. Recurrence rates are typically higher in the ICU population as those patients usually have immunocompromised systems, more exposure to antibiotics and proton pump inhibitors, loss of normal nutritional balance, and alterations in their colonic flora. Emergence of more virulent and pathogenic strains has made combating the infection even more difficult. Newer therapies, chemotherapeutic agents, and vaccinations are on the horizon. However, the most effective treatments to date are ceasing the inciting agent, reduction in the use of proton pump inhibitors, and prevention of the disease. In this chapter, we will explore the risk factors, diagnosis, treatment, and prevention of C. difficile infections (CDI) in the ICU.

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Probiotics for recurrent Clostridium difficile disease

Cited by 89 publications

References 10 publications

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

Treatment Strategies for Recurrent Clostridium difficile Infection

Clostridium difficile in the ICU

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