Do Probiotics Plus Antibiotics Prevent C. difficile?

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Nothing says Thanksgiving like an article on C. diff. Enjoy your holiday, and watch out for that contaminated romaine lettuce…again.

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Written by Clay Smith

Spoon Feed
Probiotics decrease the risk of C. difficile infection in adults and children taking antibiotics (NNT = 40) and may reduce overall adverse events like cramping, nausea, or diarrhea.

Why does this matter?
C. difficile colitis is a serious illness with significant associated morbidity and mortality. Recent guidelines tell how to diagnose and treat it. But it’s better to prevent it altogether.

Fight germs with germs
This is part of the JAMA Clinical Evidence Synopsis series. The question is: “In adults and children prescribed antibiotics, is co-administration of a probiotic associated with a lower risk of symptomatic Clostridium difficile infection without an increase in adverse events?” The answer, after arduously reviewing 39 RCTs (33 adult/6 pediatric) with almost 10,000 patients, was yes. There is moderate quality evidence that probiotics, such as Saccharomyces, Lactobacilli, Bifidobacteria, and Streptococci were effective in reducing risk of C. difficile colitis, NNT = 40. There were also fewer patients with adverse events like diarrhea, nausea, or cramping. And there was no evident harm from probiotics. So, looks like this is something we can recommend to patients whom we have given antibiotics. Probiotics are over-the-counter. Per organism cost is very reasonable. I was able to find 100 million lactobacilli for 11 bucks. That’s just 0.000011 cents per bacterium. What a bargain! Buy now. These great prices won’t last forever.

Source
Probiotics to Prevent Clostridium difficile Infection in Patients Receiving Antibiotics. JAMA. 2018 Aug 7;320(5):499-500. doi: 10.1001/jama.2018.9064.

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