I’m Pro Probiotic

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.

Probiotic

3 thoughts on “I’m Pro Probiotic

  1. Thanks for the post–and very helpful link!

    I often tell people to consider eating live culture yogurt or taking a probiotic when on antibiotics, but I don’t really prescribe anything in particular, or drive that point home enough. Some probiotic pills can be pretty expensive over-the-counter, so the fact that “any dose, any strain” seems acceptable (until more head-to-head trials are done) is helpful advice to give. It would also be helpful to know whether eating active culture yogurt is as good as probiotic pills (likely the cheapest option for those who can tolerate dairy!)

    • I also frequently tell people to take them, or eat yogurt, especially if I’m prescribing something that is known to cause a lot of diarrhea (augmentin, especially in kids). It’s been a while since I looked into it, but yogurts are pretty variable in their amount of active cultures. I think the natural types tend to have more (versus the super sweetened commercial kinds). Anyone have more specific info?

  2. From my readings, it seems that Florastor is one of the most reliable brands; I often prescribe it for traveler’s diarrhea, as an adjunct to antibiotics, or even for IBS symptoms! The probiotics in Florastor are freeze dried, so they stay active longer. (Nb: I have no commercial interest in Florastor! :))

    OTC brands are, on the other hand, mostly poorly regulated and rarely active at the time of purchase. The exception is buying lactobacillus from a fridge in a healthfood store…. but how many of our patients have the $ for that?

    Re: yogurt – my understanding is that many brands of yogurt are *also* inactive by the time they’re purchased….. “Caveat emptor”

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