PROBIOTICS FOR INTESTINAL INFECTIONS AND ANTIBIOTIC-ASSOCIATED DIARRHEA

Usually Lactobacillus spp. and Saccharomyces spp.

Lactobacillus GG is available in the US ("Culturelle," from Conagra, Inc., Omaha)

• For prevention of antibiotic-associated diarrhea
  • Risk of antibiotic-associated diarrhea was shown to be decreased from 25% to 8% with once-daily oral administration of 10-20 billion CFE (depending on weight) of Lactobacillus GG (aka L. casei or L. rhamnosus) in a placebo-controlled randomized study of 202 healthy children receiving abx for minor infections (J. Peds. 135:564, 1999--JW)
  • In a meta-analysis of 9 randomized trials (2 in children), use of probiotics concurrently with antibiotics, compared with placebo + abx, was ass'd with a composite OR for antibiotic-associated diarrhea of 0.39 with yeast (Saccharomyces boulardii) and 0.34 with lactobvacilli (BMJ 324:1361, 2002--abst)
  • In a meta-analysis of 6 randomized trials of probiotics for prevention of antibiotic-associated diarrhea in children, use of probiotics was associated with a sig. reduction in incidence (from 28.5% to 11.9%).  Effectiveness was limited to Lactobacillus GG; Saccharomyces boulardii, and Bifidobacterium lactis/Streptococcus thermophilus; Lactobacillus acidophilus was not found to be effective.  (J. Peds. 149:367, 2006--JW)

• For treatment of diarrhea due to Rotavirus in infants--Lactobacillus GG reduces duration, may reduce severity
• For treatment of atopic dermatitis in infants--In a randomized trial of 27 infants with atopic dermatitis who were exclusively breastfed, switching to formula + either Lactobacollus GG or Bifidobacterium lactis was ass'd with sig. decreases in severity; switching to plain formula alone not ass'd with sig. decrease in severity (Reported at Am. Soc. for Clin. Nutrition--FP News 6/1/00)
• For treatment of Irritable Bowel Syndrome