Do probiotics reduce C diff risk in hospitalized patients?
A systematic review and meta-analysis says, “Yes,” but that doesn’t necessarily mean they will start appearing on hospital formularies.
PRACTICE CHANGER
Start probiotics within 1 to 2 days of starting antibiotics in hospitalized patients to reduce the risk of Clostridium difficile infection.1
STRENGTH OF RECOMMENDATION
A: Based on a meta-analysis of randomized controlled trials.
Shen NT, Maw A, Tmanova LL, et al. Timely use of probiotics in hospitalized adults prevents Clostridium difficile infection: a systematic review with meta-regression analysis. Gastroenterology. 2017;152:1889-1900. e9.
CHALLENGES TO IMPLEMENTATION
Lack of “medication” status leads to limited availability in hospitals
The largest barrier to giving probiotics to hospitalized adult patients is the availability of probiotics on local hospital formularies. Probiotics are not technically a medication; they are not regulated or approved by the US Food and Drug Administration and thus, insurance coverage and availability for inpatient use are limited. Lastly, US cost-effectiveness data are lacking, although such data would likely be favorable given the high costs associated with treatment of CDI.
ACKNOWLEDGMENT
The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center For Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center For Research Resources or the National Institutes of Health.
