Advertisement
ADVANCED SEARCH

This Article Figures Only Full Text Full Text (PDF) [Online Appendices] Correction (v173,p345) Submit a response View responses Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dendukuri, N. Articles by Brophy, J. M. Search for Related Content PubMed PubMed Citation Articles by Dendukuri, N. Articles by Brophy, J. M. Related Collections Clostridium difficile

Probiotic therapy for the prevention and treatment of Clostridium difficile-associated diarrhea: a systematic review

From the Technology Assessment Unit, McGill University Health Centre (Dendukuri, Costa, McGregor, Brophy); the Department of Medicine (McGregor, Brophy); and Department of Epidemiology and Biostatistics, McGill University, Montréal, Que. (Dendukuri)

Correspondence to: Dr. Nandini Dendukuri, Technology Assessment Unit, R4.09 Ross Pavilion, Royal Victoria Hospital, Montréal QC H3A 1A1; fax 514 843-1493; nandini.dendukuri{at}mcgill.ca

Abstract

Background: The recent increase in the number and severity of cases of nosocomial Clostridium difficile-associated diarrhea (CDAD) has prompted interest in the use of probiotics for the prevention and treatment of this disease. We performed a systematic review of randomized controlled trials to assess the effectiveness of probiotic therapy.

Methods: We searched the PubMed, EMBASE, INAHTA, HEN and Cochrane Collaboration databases to identify trials in which the prevention or treatment of CDAD with probiotic therapy was the primary or secondary outcome. We extracted data on the number of patients randomly assigned to receive probiotic or placebo, the number of patients with CDAD, the type of probiotic, criteria for diagnosing CDAD, persistence of infection after treatment, compliance and adverse effects.

Results: We identified 4 eligible studies in which prevention (n = 1) or treatment (n = 3) of CDAD was the primary outcome. The benefit of probiotic therapy seen in 2 of the studies was restricted to subgroups characterized by severe CDAD and increased use of vancomycin. The remaining 2 studies were too methodologically flawed for us to draw meaningful conclusions. We also identified 4 trials in which prevention of antibiotic-associated diarrhea with probiotics was the primary outcome and prevention of CDAD a secondary outcome. These studies were limited primarily by too few CDAD cases and provided no evidence of effective prophylaxis. Overall, heterogeneity in choice and dose of probiotic and in criteria for diagnosing CDAD makes it difficult to synthesize information from the 8 studies.

Interpretation: Studies conducted to date provide insufficient evidence for the routine clinical use of probiotics to prevent or treat CDAD. Better designed and larger studies are needed.

This article has been cited by other articles:

				O. M. Williams and R. C. Spencer The management of Clostridium difficile infection Br. Med. Bull., September 1, 2009; 91(1): 87 - 110. [Abstract] [Full Text] [PDF]

				K. MILLER and T. FRASER Q: What is the role of probiotics in the treatment of acute Clostridium difficile-associated diarrhea? Cleveland Clinic Journal of Medicine, July 1, 2009; 76(7): 391 - 392. [Full Text] [PDF]

				I. A. Critchley, L. S. Green, C. L. Young, J. M. Bullard, R. J. Evans, M. Price, T. C. Jarvis, J. W. Guiles, N. Janjic, and U. A. Ochsner Spectrum of activity and mode of action of REP3123, a new antibiotic to treat Clostridium difficile infections J. Antimicrob. Chemother., May 1, 2009; 63(5): 954 - 963. [Abstract] [Full Text] [PDF]

				C. L. Rohde, V. Bartolini, and N. Jones The Use of Probiotics in the Prevention and Treatment of Antibiotic-Associated Diarrhea With Special Interest in Clostridium difficile-Associated Diarrhea Nutr Clin Pract, February 1, 2009; 24(1): 33 - 40. [Abstract] [Full Text] [PDF]

				J. Halsey Current and future treatment modalities for Clostridium difficile-associated disease Am. J. Health Syst. Pharm., April 15, 2008; 65(8): 705 - 715. [Abstract] [Full Text] [PDF]

				M. E. Pelleschi Clostridium difficile-Associated Disease: Diagnosis, Prevention, Treatment, and Nursing Care Crit. Care Nurse, February 1, 2008; 28(1): 27 - 35. [Full Text] [PDF]

				C. R. Emerson Clostridium difficile Associated Diarrhea, an Emerging Epidemic: Therapeutic Options Journal of Pharmacy Practice, August 1, 2007; 20(4): 347 - 353. [Abstract] [PDF]

				M. de Vrese and P. R. Marteau Probiotics and Prebiotics: Effects on Diarrhea J. Nutr., March 1, 2007; 137(3): 803S - 811S. [Abstract] [Full Text] [PDF]

				J. G. Bartlett Narrative Review: The New Epidemic of Clostridium difficile-Associated Enteric Disease. Ann Intern Med, November 21, 2006; 145(10): 758 - 764. [Abstract] [Full Text] [PDF]

				B. C. Johnston, A. L. Supina, and S. Vohra Probiotics for pediatric antibiotic-associated diarrhea: a meta-analysis of randomized placebo-controlled trials. Can. Med. Assoc. J., August 15, 2006; 175(4): 377 - 383. [Abstract] [Full Text] [PDF]

				S. Khan Biopeptides and immune exclusion Can. Med. Assoc. J., January 3, 2006; 174(1): 65 - 66. [Full Text] [PDF]

eLetters:

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH
Copyright 1995-2005, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.