Written by Greg Arnold, DC, CSCS. Four weeks of treatment with a combination of 4 probiotics significantly reduced the severity and number of days of diarrhea in participating subjects who were suffering from an initial infection with Clostridium difficile.
Bacterial infections are a significant health problem in the United States. Once such bacterium is Clostridium difficile, which, according to the Centers for Disease Control and Prevention (CDC) was responsible for 450,000 infections in 2012 and an estimated 25,000 annual deaths in the United States 1. Treating Clostridium infections are a major challenge. The bacterium is extremely resilient; a 2005 study showed that of the 103 metronidazole-treated patients, 28% had a recurrence of Clostridium difficile within 90 days post-treatment 2.
The primary symptom of Clostridium difficile infection is diarrhea, with prolonged bouts putting the patient at risk for bowel perforation, sepsis and death. As far back as 2012, the CDC cautioned against the overuse of antibiotics to treat viral infections such as ear and sinus which disrupt the normal intestinal bacteria and contribute to antibiotic resistance. Because of the poor response to antibiotic therapy, finding alternative and more effective protocols for prevention and treatment are warranted 3. In a 2015 study 4, 31 subjects (9 males, 22 females) between the ages of 42 and 73 and suffering from “an initial episode” of a Clostridium Difficile infection were given a four-week intervention of either a daily capsule containing a placebo or a daily capsule of 1.7×1010 colony-forming units of the following four different probiotics:
- Lactobacillus acidophilus NCFM, 7003963
- Lactobacillus paracasei Lpc-37,ATCC SD5275
- 2 different strains of Bifidobacterium lactis Bi-07, ATCC SC5220
- Bifidobacterium lactis Bl-04, ATCC SD5219
After four weeks, those in the probiotic group had a significant reduction in the number of days of having diarrhea [70.9% fewer days (3.5 versus 12 days), p = 0.005)] as well as a significant reduction in severity of diarrhea during the course of the infection (p = 0.009).
The researchers cited the importance of these results, however, added that while “ingestion of specific probiotic strains during antibiotic therapy significantly reduces the risk of developing a Clostridium infection 5-7, studies evaluating the effectiveness of probiotics as treatment during an initial Clostridium episode are lacking.”
A limitation of this study is its small sample size which might not reflect a true difference between treatment groups; therefore, larger studies using this probiotic combination are warranted.
In additional to recommending additional studies “to investigate this finding in a larger patient population,” the researchers cited these results as “promising” because “given the current burden of Clostridium infections in hospitals, even a small decrease in diarrhea duration for patients is poised to have a considerable impact on disease transmission and antibiotic usage.”
Source: Barker, Anna, Megan Duster, Susan Valentine, Laurie Archbald-Pannone, Richard Guerrant, and Nasia Safdar. “Probiotics for Clostridium difficile infection in adults (PICO): Study protocol for a double-blind, randomized controlled trial.” Contemporary clinical trials 44 (2015): 26-32.
©The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
Posted October 9, 2017.
Greg Arnold is a Chiropractic Physician practicing in Hauppauge, NY. You can contact Dr. Arnold directly by emailing him at PitchingDoc@msn.com or visiting his web site at www.PitchingDoc.com.
References:
- Lessa FC, Mu Y, Bamberg WM, et al. Burden of Clostridium difficile infection in the United States. New England Journal of Medicine. 2015;372(9):825-834.
- Musher DM, Aslam S, Logan N, et al. Relatively poor outcome after treatment of Clostridium difficile colitis with metronidazole. Clinical infectious diseases. 2005;40(11):1586-1590.
- Foundation CD. C. diff. — Educating and Advocating for the Prevention, Treatment and Environmental Safety of Clostridium Difficile Infections Worldwide. 2017; https://cdifffoundation.org/. Accessed October 3, 2017, 2017.
- Barker A, Duster M, Valentine S, Archbald-Pannone L, Guerrant R, Safdar N. Probiotics for Clostridium difficile infection in adults (PICO): Study protocol for a double-blind, randomized controlled trial. Contemporary clinical trials. 2015;44:26-32.
- Goldenberg JZ, Ma SS, Saxton JD, et al. Probiotics for the prevention of Clostridium difficile‐associated diarrhea in adults and children. The Cochrane Library. 2013.
- McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. The American journal of gastroenterology. 2006;101(4):812.
- Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. Jama. 2012;307(18):1959-1969.
