Cochrane Database Syst rev 2017 Dec 19; 12:CD006095. (https://doi.org/10.1002/14651858.CD006095.pub4)
についての NEJM JW.
Probiotics should not be given to patients who are immunocompromised, are pregnant, are in intensive care, or have prosthetic heart valves or certain preexisting gastrointestinal disorders (e.g., inflammatory bowel disease, ostomy)
Do Probiotics Prevent C. difficile-Associated Diarrhea in Patients receiving Antibiotics?
— Daniel D. Dressler, MD, MSc, SFHM, FACP
A meta-analysis suggests that most inpatients — with specific exclusions — benefit from probiotic prophylaxis.
Hospitalization and antibiotic use are major independent risk factors for Clostridium difficile-associated diarrhea (CDAD), and probiotic prophylaxis can lessen CDAD’s occurrence (NEJM JW Gastroenterol May 2017 andGastroenterology 2017; 152:1889), but guidelines have not yet endorsed broad use of this preventive intervention.
In this meta-analysis of 31 randomized trials that involved >8500 patients (7000 were inpatients, 7800 were adults, 1100 were children, and 2500 had baseline CDAD risk >5%), CDAD incidence was significantly lower in all patient groups with probiotics versus with control:
All patients: probiotics 1.5%, control 3.9%; number needed to treat (NNT), 42
Inpatients: probiotics 1.7%, control 4.2%; NNT, 40
Adults: probiotics 1.4%, control 3.3%; NNT, 53
Children: probiotics 2.5%, control 7.5%; NNT, 20
Patients with CDAD risk >5%: probiotics 3.1%, control 11.6%; NNT, 12
Adverse events (e.g., abdominal cramping, nausea, fever, flatulence, taste disturbance) were less likely with probiotics (14.3% vs. 17.0%; NNT, 37), and no episodes of severe probiotic-associated adverse effects (e.g., bacteremia, fungemia) were identified.
Moderate-quality evidence supports a significant protective effect of probiotics against CDAD. Probiotics should not be given to patients who are immunocompromised, are pregnant, are in intensive care, or have prosthetic heart valves or certain preexisting gastrointestinal disorders (e.g., inflammatory bowel disease, ostomy). For most other hospital- ized patients who receive antibiotics during hospitalization, prescribing 20 to 50 billion colony forming units of probi- otics daily (starting within 24–48 hours of antibiotic initiation) can prevent CDAD.
Goldenberg JZ et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children.Cochrane Database Syst rev 2017 Dec 19; 12:CD006095. (https://doi.org/10.1002/14651858.CD006095.pub4)