C. difficile is linked to over 450,000 infections and 15,000 deaths in the US every year, and represents a huge burden on the healthcare system. Multiple randomized controlled trials (RCTs) have shown that specific probiotics may help reduce the risk of a C. difficile infection when taken in combination with antibiotics. However, evidence is scarce to support a role for the beneficial microorganisms in combination with antibiotics during an initial C. diff infection.
Researchers from the Universities of Wisconsin and Virginia now report that, according to their small exploratory study, a combination of Lactobacillus acidophilus NCFM, L. paracasei Lpc-37, Bifidobacterium lactis Bi-07 and B. lactis Bl-04 may improve outcomes, particularly for diarrhea.
“In this pilot study, a combination probiotic was found to decrease significantly the duration of CDI [C. difficile infection] diarrhea compared with a placebo control. Additional studies are needed to investigate this finding in a larger patient population, but these results are promising,” wrote the researchers in the Journal of Antimicrobial Chemotherapy.
“Given the current burden of CDIs in hospitals, even a small decrease in diarrhea duration for patients is poised to have a considerable impact on C. difficile transmission and antibiotic usage and warrants rigorous assessment in efficacy trials.”
“Considering the cost of CDAD; even small reductions have substantial financial implications”
Commenting on the results of the study, the Scientific Committee of the International Probiotics Association told NutraIngredients-USA: “The study of course fits well in the overall body of evidence of probiotics in the field of antibiotic-associated diarrhea/ C. difficile-associated diarrhea risk reduction.
“Considering the cost of CDAD; even small reductions have substantial financial implications; in addition to the improvement in quality of life.
“The study is, however, very small (it was a pilot study). Another point is that there is a difference (although not significant p=0.16) in the number of days on antibiotics; which is shorter for the probiotic group. If and how this may have influenced the results is difficult to say.”
The researchers recruited 33 people with an initial mild to moderate CDI to participate in their pilot randomized trial. The participants all received the standard antibiotic treatment with or without the 28 day course of probiotics at a daily dose of 17 billion colony forming units (CFUs) per capsule.
Results showed that the placebo group had diarrhea for an average of one day more than people in the probiotic group, but there was no difference between the groups for recurrence.
In addition, the total number of days with diarrhea days and the of diarrhea were significantly reduced in the probiotic group compared with placebo.
“To our knowledge, no other studies have investigated probiotics as adjunct therapy for initial CDIs. Existing studies focused on probiotics for the prevention of initial and recurrent CDIs and recurrent CDI treatment. Transient probiotic GI colonization is a key component of the biological mechanism reducing CDI in all these clinical situations. Our findings trend in the same direction as recent meta-analyses evaluating probiotic RCTs in the other C. difficile contexts,” wrote the researchers.
“Probiotics are a promising adjunct therapy for treatment of an initial CDI and should be further explored in a larger randomized controlled trial,” they concluded.
Source: Journal of Antimicrobial Chemotherapy
Published online ahead of print, doi: 10.1093/jac/dkx254
“A randomized controlled trial of probiotics for Clostridium difficile infection in adults (PICO)”
Authors: A.K. Barker et al.