Probiotics for treatment of Clostridium difficile-associated colitis in adults.
BACKGROUND
Probiotics are live microorganisms consisting of non-pathogenic yeast and bacteria that are believed to restore the microbial balance of the gastrointestinal tract altered by infection with Clostridium difficile (C. difficile).


OBJECTIVE
To assess the efficacy of probiotics in the treatment of antibiotic associated C. difficile colitis.


METHODS
The databases MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and Cochrane IBD/FBD Specialized Trials register were searched to locate all published reports from 1966 to 2007.


METHODS
Randomized, prospective studies using probiotics alone or in conjunction with conventional antibiotics for the treatment of documented C. difficile colitis were eligible for inclusion.


METHODS
Data extraction and analysis was done independently by two authors.


RESULTS
Four studies met the inclusion criteria and were included in the review. The four studies examined the use of probiotics in conjunction with conventional antibiotics (vancomycin or metronidazole) for the treatment of recurrence or an initial episode of C. difficile colitis in adults. The studies were small in size and had methodological problems. A statistically significant benefit for probiotics combined with antibiotics was found in one study. McFarland 1994 found that patients receiving S. boulardii were significantly less likely than patients receiving placebo to experience recurrence of C. difficile diarrhea (RR 0.59; 95% CI 0.35 to 0.98). No benefit of probiotics treatment was found in the other studies.


CONCLUSIONS
There is insufficient evidence to recommend probiotic therapy as an adjunct to antibiotic therapy for C. difficile colitis. There is no evidence to support the use of probiotics alone in the treatment of C. difficile colitis.
Pillai
A
A
Cleveland Clinic, Digestive Diseases Center, 9500 Euclid Avenue, Cleveland, OH 44195, USA. pillaia@ccf.org
Nelson
R
R
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000628:therapy*; D006801:Humans; D048191:Lactiplantibacillus plantarum; D052201:Lacticaseibacillus rhamnosus; D019936:Probiotics / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012440:Saccharomyces
D000900:Anti-Bacterial Agents