Probiotic Use for Clostridium Difficile Infection
The Pennsylvania Patient Safety Authority received responses to an article that appeared in the March 18, 2010, supplement to the Pennsylvania Patient Safety Advisory. Representatives of Pennsylvania nursing homes commented that their facilities administer probiotics (live microorganisms) for the prevention and treatment of Clostridium difficile infection (CDI).
Probiotics are considered dietary supplements and are therefore not approved by the U.S. Food and Drug Administration.1,2 Conflicting media reports about the use of probiotics have created confusion among healthcare professionals and the public, and further studies are needed to determine their efficacy.3
Authority analysts reviewed the clinical literature to determine the efficacy of probiotics for the prevention and treatment of gastrointestinal illness, including CDI. The Authority’s review found conflicting results. For example, McFarland reviewed various studies that tested probiotics to prevent antibiotic-associated diarrhea. Findings included that there may be a true benefit in using these supplements, as evidenced by the reduction of frequency of diarrhea in the probiotic group versus placebo groups. In contrast, other studies revealed little or no benefit with respect to control of diarrhea.4 Another example includes Bartlett’s review of several studies that found similar results to McFarland.1 In addition, Bartlett also reported the incidence of fungemia (i.e., fungal infection of the blood) as a result of probiotic use. 1
The most recent C. difficile guidelines released in March 2010 by the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America do not recommend the administration of currently available probiotics because “there are limited data to support this approach, and there is a potential risk of bloodstream infection.”5
- Bartlett J. New antimicrobial agents for patients with Clostridium difficile infections. Curr Infect Dis Rep 2009 Jan;11(1):21-8.
- U.S. Food and Drug Administration. Guidance for industry on complementary and alternative medicine products and their regulation by the food and drug administration [draft guidance online]. 2006 Dec [cited 2010 Apr 9]. Available from Internet: http://www.fda.gov/downloads/RegulatoryInformation/Guidances/UCM145405.pdf.
- Weichselbaum E. Potential benefits of probiotics―main findings of an in-depth review. Br J Community Nurs 2010 Mar;15(3):110-4.
- McFarland LV. Evidence-based review of probiotics for antibiotic-associated diarrhea and Clostridium difficile infections. Anaerobe 2009 Dec;15(6):274-80.
- Cohen SH, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010 May;31(5):431-55.