Probiotics use for antibiotic-associated diarrhea: a pragmatic participatory evaluation in nursing homes

Abstract

Background: Antibiotic-associated diarrhea (AAD) occurs in 2-25% of nursing home residents, which may lead to dehydration, malnutrition, severe complications and hospitalizations. Research shows that probiotics can be effective and safe in reducing AAD. However, probiotics are not routinely used in Dutch nursing homes. The objectives of this evaluation were to develop a procedure for the implementation of probiotics to prevent AAD in nursing homes, to evaluate effects on AAD occurrence, and to evaluate the implementation process of probiotics in daily care. Methods: A pragmatic participatory evaluation (PPE) design was chosen, as it seemed a suitable approach for implementation of probiotics, as well as for evaluation of its effectiveness in daily nursing home practice. Probiotics administration was implemented in three nursing homes of the Rivas Zorggroep for residents with somatic and/or psychogeriatric conditions. Ninety-three residents provided data on 167 episodes of antibiotics use, of which 84 episodes that included supplementation with probiotics and 83 episodes with no probiotics supplementation. A multispecies probiotics was administered twice daily upon start of antibiotic treatment, up to 1 week after completing the antibiotics course. The occurrence of AAD was monitored and a process evaluation was conducted to assess facilitators and barriers of probiotics implementation. Results: The number of episodes with AAD when using probiotics was significantly lower than when no probiotics was used (20% vs 36%; p = 0,022, Chi-square). No significant differences in the occurrence of AAD were found between the residents taking amoxicillin/clavulanic acid or ciprofloxacin. Reported facilitators for implementation were perceived benefits of probiotics and prescription by medical staff. Reported challenges were probiotics intake by residents and individual decision-making as to which resident would benefit from it. Conclusion: Successful implementation of probiotics demonstrated the prevention of AAD in nursing home residents.

Probiotics as Potential Antimicrobials for the Treatment of Infections: Current Reality or Remote Future?

“…Probiotics are also indicated to reduce or prevent diarrhea associated with antibiotics and infections by Clostridium difficile, common in hospitalized patients [117,118] and the elderly [119]. In children, its effectiveness in preventing antibiotic-associated diarrhea [120] and in treatment for acute gastroenteritis has not been confirmed, despite reducing the duration of hospitalization [121].…”

Multispecies probiotics promote perceived human health and wellbeing: insights into the value of retrospective studies on user experiences

“…Studied in antibiotic-associated diarrhoea (Hell et al, 2013;Koning, 2010;Koning et al, 2008;Lang, 2010;Van Wietmarschen et al, 2020) inflammatory bowel disease (Hemert et al, 2013;Lutgendorff, 2009;Mulder, 2008;Persborn et al, 2013;Van der Waal et al, 2019) Constipation (Bekkali et al, 2007;De Milliano et al, 2012) gastrointestinal complaints (Grossenbacher et al, 2016) 1 With the application of new molecular identification techniques (including whole genome sequencing), the declaration of bacterial strains of Ecologic Relief has been updated compared to previous publications. It has been confirmed that the probiotic formulation has always contained these seven strains, and has not been changed in ratio or cfu count since it has been (commercially) available.…”

The Development of High-Quality Multispecies Probiotic Formulations: From Bench to Market

“…Ninety-three residents provided data on 167 episodes of antibiotics use, of which 84 episodes included supplementation with probiotics and of which 83 episodes did not include probiotics supplementation. The number of episodes with AAD when using probiotics was significantly lower than when no probiotics were used (20% vs. 36%; p = 0.022, Chi-square) [ 62 ].…”