Probiotic drink ‘a viable alternative’ to supplements for diarrhoea prevention

The beverage—Danone’s probiotic yogurt drink, Danactive—contains 10 billion colony-forming units (cfu) of Lactobacillus casei sp. Paracasei​ CNCM I-1518. It appeared to reduce cases of AAD and CDI when compared to the control group.

“Patients find the commercially available probiotic beverages acceptable and have demonstrated a willingness to consume while taking an oral diet,”​ said the Canadian team, led by Cathy Alberda, clinical practice and research lead at Alberta Health Services.

“It appears that a Lactobacillus probiotic drink is feasible and safe for ICU patients, however, optimal dose and strain remains elusive. ​

Commercial probiotic drinks ​

The use of a probiotic drink to reduce bacterial infection is not a new one. Danone’s Actimel probiotic drink featured in a study​​ in which 135 patients received 100 grams (g) of the probiotic twice daily during and for one week after antibiotic therapy.

Seven of 57 (12%) of the probiotic group developed ADD compared with 19/56 (34%) in the placebo group, who received a sterile milkshake.

Meanwhile, a head-to-head comparison​​ featuring probiotic drinks, Actimel (Lactobacillus casei defensis DN-114001​) and Yakult (Lactobacillus casei Shirota​) resulted in a diarrhoea frequency in the Actimel group of 30 participants at 6.7%.

The presence of AAD was much higher in the Yakult group also of 30 participants at 33.3%.

Study details ​

In this latest study, patients housed in the intensive care unit (ICU) that were undergoing antibiotic treatment, were recruited and matched with contemporary controls.

Study patients received two bottles daily of the probiotic drink, which was administered via a feeding tube.

Tolerance to probiotics and enteral nutrition, development of adverse events, and incidence of AAD was recorded. CDI rates were also followed for 30 days post antibiotic treatment.

Findings proved positive for the 32 patients enrolled in the case-controlled trial as no serious adverse events in the probiotic group were recorded compared to three in the control group.

AAD was documented in 12.5% of the probiotic group and 31.3% in the control group. One patient in the probiotic group developed CDI compared to three in the control group.

“Although no statistical significance was shown, the incidence of AAD in combination with high risk antibiotic administration is noteworthy,”​ the team said.

“There was no difference in the incidence of CDI between the probiotic and control groups; one patient in the probiotic group developed CDI on Day 5 and did not experience any serious adverse effects.​

“In contrast, three patients in the control group developed CDI and went on to develop severe adverse events.​

“Two of these patients developed CDI in ICU while receiving antibiotics while the third patient developed CDI on Day 30 after transfer to the ward while continuing antibiotic treatment. There were no major adverse events in the probiotic group.”​

Two of the limitations of the study highlighted the unknown osmolality (concentration of the particles dissolved in a fluid) and flavour of the probiotic drink.

The study pointed to these factors as possibly influential in the three incidents of vomiting in the probiotic cohort.

“A cost-effectiveness analysis is required to determine if a commercially available probiotic drink added to patients’ oral diets or EN is efficacious and provides a viable alternative to probiotic supplements for the prevention of AAD and CDI in ICU and hospitalised patients,”​ the study concluded.

Source: Nutrients​
Published online ahead of print: doi:10.3390/nu10050539​​
“Feasibility of a Lactobacillus casei Drink in the Intensive Care Unit for Prevention of Antibiotic Associated Diarrhea and Clostridium difficile.”​
Authors: Cathy Alberda, Sam Marcushamer, Tayne Hewer, Nicole Journault and Demetrios Kutsogiannis