Studies of antibiotic-associated Clostridium difficile diarrhea treated with probiotics

Study designFindingsReference
Standard antibiotic for 10 days plus either S. boulardii (1 g/day for 28 days) or placeboSignificant decrease in recurrences in patients treated with vancomycin (2 g/day) and S. boulardii (16.7%) compared with vancomycin and placebo (50%; P = 0.05)137
Standard antibiotic plus L. rhamnosus GG in prospective, randomized, placebo-controlled trial3-week recurrence rate of C. difficile infection reduced and improved patient well-being with earlier disappearance of abdominal cramps and diarrhea101
Prospective double-blind controlled trial of 180 hospitalized patients given antibiotic plus S. boulardiiSignificantly reduced the rate of diarrhea from 22% in the placebo group to 9.5% in the S. boulardii group136
Prospective, randomized, double-blind, placebo-controlled trial of 302 hospitalized patients on antibiotics who received Lactobacillus GG (2 × 1010 CFU/day) or placebo for 14 daysDiarrhea developed in 39 (29.3%) of 133 patients in the GG group and 40 (29.9%) of 134 placebo patients (P = 0.93)143
69 patients over the age of 65 yr prescribed antibiotics were randomized to receive either 113 g of S. boulardii twice daily or placebo for as long as they received antibioticsNo evidence that S. boulardii altered patients' bowel habits or prevented the appearance of C. difficile toxin in the stool71
Meta-analysis to evaluate efficacy of probiotics in prevention and treatment of diarrhea associated with the use of antibioticsOdds ratio of 0.39 (95% CI, 0.25 to 0.62; P < 0.001) in favor of active treatment over placebo using S. boulardii and 0.34 (0.19 to 0.61; P < 0.01) for lactobacilli33