Thursday, December 27, 2012

Probiotics for the Prevention of C.difficile

The prevention of C.difficile associated diarrhea is a growing area of interest, particularly for patient on antibiotic therapy. Here is a systematic review published in the Annals of Internal Medicine on the use of probiotics for the prevention of C.difficile associated diarrhea.

Twenty trials including 3818 participants met the eligibility criteria. Probiotics reduced the incidence of C.difficile associated diarrhea by 66% (pooled relative risk, 0.34 [95% CI, 0.24 to 0.49]; I2 = 0%). Of probiotic-treated patients, 9.3% experienced adverse events, compared with 12.6% of control patients (relative risk, 0.82 [CI, 0.65 to 1.05];I2 = 17%).

This is reasonable quality evidence to support the use of probiotics to reduce the risk of C.difficile associated diarrhea. The potential harm is minimal.

Who would best benefit from probiotics? This is not clearly defined, however, prescription of probiotics for those receiving prolonged antibiotics (> 2 weeks) or for those on antibiotics with a prior history of C.difficile associated diarrhea seems justifiable.

It may change my practice.


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