UK Study Shows Benefit From Probiotic Drink

A study
published in the British
Medical Journal indicates that use of a href="http://en.wikipedia.org/wiki/Probiotic" rel="tag">probiotic
drink can reduce the frequency of antibiotic-associated diarrhea in
general, and of href="http://en.wikipedia.org/wiki/Clostridium_difficile"
rel="tag">Clostridium difficile
colitis in particular.



Antibiotic-associated colitis is a complication of treatment with
antibiotics.  About 15 to 25 percent of such cases are caused
by C. difficile.  



C. difficile is particularly nasty.  It
produces a toxin, can lead to bowel perforation, href="http://www.nlm.nih.gov/medlineplus/ency/article/001355.htm"
rel="tag">septicemia, and death.
 Therefore, prevention is highly desirable.  

rev="review"
href="http://www.bmj.com/cgi/content/full/bmj.39231.599815.55v1">Use
of probiotic Lactobacillus preparation to prevent diarrhoea associated
with antibiotics: randomised double blind placebo controlled trial

Hickson M, et. al.

BMJ, doi:10.1136/bmj.39231.599815.55 (published 29 June 2007)

Objective
To determine the
efficacy of a probiotic drink containing Lactobacillus
for the prevention of any diarrhoea associated with antibiotic use and
that caused by Clostridium difficile.



Design Randomised double blind placebo controlled
study.



Participants 135 hospital patients (mean age 74)
taking antibiotics. Exclusions included diarrhoea on admission, bowel
pathology that could result in diarrhoea, antibiotic use in the
previous four weeks, severe illness, immunosuppression, bowel surgery,
artificial heart valves, and history of rheumatic heart disease or
infective endocarditis.



Intervention Consumption of a 100 g (97 ml) drink
containing Lactobacillus casei, L bulgaricus, and
Streptococcus thermophilus twice a day during a course of
antibiotics and for one week after the course finished. The placebo
group received a longlife sterile milkshake.



Main outcome measures Primary outcome: occurrence
of antibiotic associated diarrhoea. Secondary outcome: presence of C
difficile toxin and diarrhoea.



Results 7/57 (12%) of the probiotic group
developed diarrhoea associated with antibiotic use compared with 19/56
(34%) in the placebo group (P=0.007). Logistic regression to control
for other factors gave an odds ratio 0.25 (95% confidence interval 0.07
to 0.85) for use of the probiotic, with low albumin and sodium also
increasing the risk of diarrhoea. The absolute risk reduction was 21.6%
(6.6% to 36.6%), and the number needed to treat was 5 (3 to 15). No one
in the probiotic group and 9/53 (17%) in the placebo group had
diarrhoea caused by C difficile (P=0.001). The
absolute risk reduction was 17% (7% to 27%), and the number needed to
treat was 6 (4 to 14).



Conclusion Consumption of a probiotic drink
containing L casei, L bulgaricus, and S
thermophilus
can reduce the incidence of antibiotic associated diarrhoea and C
difficile associated
diarrhoea. This has the potential to decrease morbidity, healthcare
costs, and mortality if used routinely in patients aged over 50.

The reason I like this kind of study is that it is fairly
straightforward.  It shows that something simple and
inexpensive can have a significant effect on reducing the sickness and
death caused by something that is fairly common.  



The only caveat is that two of the authors have an association with the
company that makes the probiotic drink used in the study.  I
doubt this influenced the results very much, because what they used is
basically rel="tag">yogurt.  The patent expired
about 4,480 years ago, so nobody is going to make a fortune off of this.