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Clostridium difficile Infections: Diagnosis, Treatment, and Prevention

Slide: 23 of 33

Comparative Effectiveness Results for Treatment of CDI With Antibiotics + Adjunctive Therapy

Probiotics are a very active area of discussion for CDI. Probiotics are live microorganisms, including bacteria or yeast, which, when administered in adequate amounts, confer a health benefit on the host. Probiotics are believed to replenish nonpathogenic microorganisms to GI flora that has become altered by antibiotic therapy. It is important that the effectiveness of probiotics and related substances are evaluated specifically for their effect on CDI and not rely on the more broadly defined antibiotic-associated diarrheal disease, which includes a much broader set of potential disease etiology. Although probiotics may have been intended solely for prevention of recurrent CDI in some studies, they were included among treatments for recurrent CDI because the probiotic was administered concurrently with a standard antibiotic during treatment and not after recurrent CDI was cured.

Probiotics were the only intervention administered as an adjunct to standard antibiotic treatment for CDI. The probiotic in two studies contained Sacchromyces boulardii and in one it contained Lactobacillus plantarum. In the studies analyzed here, probiotics administered as an adjunct to antibiotic treatment were not more effective than treatment with antibiotics alone. Additionally, administration of a probiotic containing Saccharomyces spp. to treat CDI in critically ill patients only increased the risk for greater morbidity and mortality from fungemia without showing any benefit.