We see a ton of people in the ED who visit us for their infectious “emergencies.” Ideally, we start them on the appropriate antibiotics and send them on their way, either out the door or upstairs as the case necessitates. Our best intentions can unfortunately give rise to unexpected side effects. It is well known that taking antibiotics opens you up to developing C. difficile infections which can lead to dehydration, malnourishment, hospitalization, and even death. It costs lots of time and money to care for and treat this untoward outcome. Due to a 2013 Cochrane review, I’ve gotten in the habit of giving an extra med for the folks needing antibiotic treatment – a probiotic.
The Cochrane group included 31 studies (including 24 RCTs) in the review which found that there was a significant reduction in C. difficile associated diarrhea (CDAD) in patients given probiotics. The incidence was 2% in the probiotic group vs 5.5% in the placebo/no treatment groups. The number needed to treat was found to be 29 patients to prevent a case of CDAD. There was also found to be a significantly lower rate of non-C. difficile antibiotic associated diarrhea as well as other adverse events (e.g. flatulence, abdominal cramping, nausea) in the group given probiotics.
Next time you are treating the little old lady with the UTI or the young lady who maybe had CMT, think about throwing on some probiotics to reduce the continuity of care in the ED. It’s pretty low risk with pretty high yield. I’ve been giving out Lactobacillus capsules myself. Feel free to check out the link.