Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children

Goldenberg, Joshua Z.; Yap, Christina; Lytvyn, Lyubov; Lo, Calvin Ka-Fung; Beardsley, Jennifer; Mertz, Dominik; Johnston, Bradley C.

doi:10.1002/14651858.cd006095.pub4

Cited by 346 publications

(278 citation statements)

References 136 publications

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“…Limited evidence supports the use of probiotics to decrease recurrence of CDI, and no effective immunotherapy is currently available 205 . Faecal microbiota transplantation (FMT) is a highly effective rescue treatment and should be considered in patients who have had >2 recurrences, as the efficacy of antibiotics in these patients is ~30%.…”

Section: Managementmentioning

confidence: 99%

Clostridium difficile infection

Smits

Lyras

Lacy

et al. 2016

Nat Rev Dis Primers

660

674

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Infection of the colon with the Gram-positive bacterium Clostridium difficile is potentially life threatening, especially in elderly people and in patients who have dysbiosis of the gut microbiota following antimicrobial drug exposure. C. difficile is the leading cause of health-care-associated infective diarrhoea. The life cycle of C. difficile is influenced by antimicrobial agents, the host immune system, and the host microbiota and its associated metabolites. The primary mediators of inflammation in C. difficile infection (CDI) are large clostridial toxins, toxin A (TcdA) and toxin B (TcdB), and, in some bacterial strains, the binary toxin CDT. The toxins trigger a complex cascade of host cellular responses to cause diarrhoea, inflammation and tissue necrosis — the major symptoms of CDI. The factors responsible for the epidemic of some C. difficile strains are poorly understood. Recurrent infections are common and can be debilitating. Toxin detection for diagnosis is important for accurate epidemiological study, and for optimal management and prevention strategies. Infections are commonly treated with specific antimicrobial agents, but faecal microbiota transplants have shown promise for recurrent infections. Future biotherapies for C. difficile infections are likely to involve defined combinations of key gut microbiota.

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Section: Managementmentioning

confidence: 99%

Clostridium difficile infection

Smits

Lyras

Lacy

et al. 2016

Nat Rev Dis Primers

660

674

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“…36 A recent Cochrane review that specifically analyzed the effect of probiotics in preventing CDAD included 3 studies on children (n = 605) and reported a relevant effect in children receiving probiotics (RR 0.37; 95% CI, 0.23-0.60). 33 Many different probiotic strains were tested and a conclusive recommendation on the most effective treatment to prevent CDAD was not released. The authors concluded that further head-to-head trials aimed at identifying optimal strains and dosages are needed for this purpose.…”

Section: Preventionmentioning

confidence: 99%

Probiotics for Prevention and Treatment of Diarrhea

Guarino

Guandalini

Vecchio

2015

Journal of Clinical Gastroenterology

154

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Probiotics are increasingly used for prevention and treatment of diarrhea more in children than in adults. Given the broad spectrum of diarrhea, this review focuses on the main etiologies: acute gastroenteritis, antibiotic-associated diarrhea (AAD), and necrotizing enterocolitis (NEC). For each, we reviewed randomized controlled trials, meta-analyses, and guidelines. For acute gastroenteritis we found 12 guidelines: 5 recommended probiotics and 7 did not. However, the guidelines containing positive recommendations provided proof of evidence from clinical trials and meta-analyses. Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii had the most compelling evidence of efficacy as they reduced the duration of the disease by 1 day. For AAD 4 meta-analyses were found, reporting variable efficacy of probiotics in preventing diarrhea, based on the setting, patient's age, and antibiotics. The most effective strains were LGG and S. boulardii. For NEC, we found 3 randomized controlled trials, 5 meta-analyses, and 4 position papers. Probiotics reduced the risk of NEC enterocolitis and mortality in preterm babies. Guidelines did not support a routine use of probiotics and asked for further data for such sensitive implications. In conclusion, there is strong and solid proof of efficacy of probiotics as active treatment of gastroenteritis in addition to rehydration. There is solid evidence that probiotics have some efficacy in prevention of AAD, but the number needed to treat is an issue. For both etiologies LGG and S. boulardii have the strongest evidence. In NEC the indications are more debated, yet on the basis of available data and their implications, probiotics should be carefully considered.

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“…Use of probiotics might be helpful in primary prevention 4142. However, US guidelines do not recommend their use outside clinical trials because of insufficient data 6…”

Section: How Can We Reduce the Risk Of C Difficile Infection?mentioning

confidence: 99%