use of probiotics in larger controlled trials in humans prevention of diarrhea antibiotic associated...

Use of Probiotics in Larger Controlled Trials in Humans

•Prevention of Diarrhea

•antibiotic associated diarrhea

•infantile diarrhea

•traveler’s diarrhea

•Treatment of Diarrhea

• Clostridium difficile disease

•acute diarrhea - pediatric and adult

D’Souza et al., BMJ 2002;324:1361

Stop Antibiotic

Start Antibiotic

Start Yeast (within 48h)

Stop Study

Yeast continued for 14d

Saccharomyces boulardii and Antibiotic Associated Diarrhea in Hospitalized PatientsN=180; site: University of Washington, Harborview Hospital

Surawicz et al., Gastroenterol. 1989;96:981

Huang, et al., Digestive Diseases and Sciences, Vol.47, No. 11 (Nov 2002)

McFarland et al., JAMA; 271, 1913-1918, (1994).

S. boulardiiS. boulardii & High Dose & High Dose Vancomycin for Vancomycin for C. difficileC. difficile Disease Disease

[Results][Results]

0

10

20

30

40

50

60

% C

DD

rec

urre

nces

50%

16.7%*

Surawicz CM. Clin Infect Dis 2000;31:1012-7.

S. boulardii (n=18)

Placebo(n=14)

*p=0.05

Other Uses for Probiotics –Limited DataOther Uses for Probiotics –Limited Data

•Crohn’s Disease

•Ulcerative Colitis

•Pouchitis

•Allergy/Exema

•Irritable Bowel Syndrome Dental caries

•High Cholesterol Urinary Tract Infections

•Helicobacter pylori

• Lactose Intolerance

•Candida vaginal infections

•Bacterial Vaginosis

Table 4. Evidence supporting uses for commercially available (USA) probiotics

Condition Lactinex L. reuteri LGG S. boulardii

Antibiotic-associated diarrhea conflicting ? good good

C. difficile disease ? ? limited good

Traveler’s diarrhea ? ? fair fair

Acute diarrhea prevention(pediatric)

? ? promising ?

Acute diarrhea treatment ? good good good

Bacterial vaginosis ? ? ? ?

Candida vulvovaginitis ? ? limited ?

Urinary tract infections ? ? ? ?

From Elmer GW, Am J. Health-Sys Pharmacy 2001;58:1101-1107

Lactobacillus plantum for IBS looks promising

Probiotics Summary

•Living microorganisms with multiple mechanisms of action

•Good safety profile

•Some applications to prevent and treat infectious diseases

•An alternative to antimicrobials in some situations

•May have other applications, e.g. allergy, colitis

•Product selection is important