What is the role of probiotics in the treatment of acute Clostridium difficile-associated diarrhea?
FEW ADVERSE EFFECTS
Adverse effects seem to be uncommon with probiotics. Untoward symptoms include flatulence, bloating, and thirst. There are reports of invasive disease, including Lactobacillus bacteremia and Saccharomyces fungemia, occurring after these probiotics were given to patients with severe comorbidities.9,10,11
BENIGN STRAINS OF C DIFFICILE MAY PROTECT AGAINST CDAD
Interestingly, C difficile itself may serve as a probiotic, preventing future episodes of CDAD. Several studies in hamsters showed that colonization with nontoxigenic strains of C difficile can prevent infection with toxigenic strains. In these studies, hamsters receiving clindamycin (Cleocin) or cefoxitin (Mefoxin) were given nontoxigenic strains of C difficile that were either susceptible or resistant to the antibiotic, followed by a toxigenic strain. Those given resistant nontoxigenic strains were significantly less likely to develop CDAD. One study, for example, found that 100% of hamsters given a clindamycin-resistant, nontoxigenic strain of C difficile were protected from CDAD.12
INFECTION CONTROL IS KEY
Novel treatments for CDAD and ways to prevent it are constantly being sought as C difficile has reemerged in hospitals across North America and Europe. However, CDAD is fundamentally a hospital-acquired infection transmitted from patient to patient via the hands of health care workers. The most common predisposing factor is antibiotic use. While new therapeutic advances would be welcome, hand hygiene, basic infection control practice, and judicious use of antimicrobials are essential to decreasing the incidence of this disease.
