Continue to expect a limited role for probiotics

Some clinicians give probiotics to help prevent antibiotic-associated diarrhea. But experts disagree over whether probiotics help reduce the risk....
Mahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition

There are more questions about using probiotics (Lacteol Forte) in the hospital for GI disorders due to new American Gastroenterology Association guidelines. Continue to expect limited use. Evidence of benefit is generally weak and study results often conflict. Plus data from one species or strain can't be applied to another.

Some clinicians give probiotics (Lacteol Forte) to help prevent antibiotic-associated diarrhea. But experts disagree over whether probiotics help reduce the risk of C. difficle from antibiotics. And some evidence suggests probiotics may prevent necrotizing enterocolitis (NEC) in preterm, low-birth-weight infants. But point out that probiotics aren't helpful for acute gastroenteritis. And there's not much evidence they improve other GI problems, such as inflammatory bowel disease or diverticulitis. Also be mindful of safety considerations with probiotics. Avoid probiotics in immunocompromised or critically ill patients. Keep in mind, probiotics are living bacteria or yeast and there are reports of bacteremia and fungemia in these patients. If probiotics are given per tube, educate nurses NOT to open capsules or packets in patient rooms. Advise prepping in areas such as medication rooms and to change gloves before and after administering.

Tweet Screenshot
Note (1)
Dosage of lacteol-forte.

Explain the live organisms within the probiotic can become airborne and transfer to surfaces or patients and have led to rare cases of bloodstream infections in patients with central lines. Separate probiotics and oral antimicrobials by 2 hours the antimicrobial could theoretically kill the "good" probiotic bugs.

References

  • Su GL, Ko CW, Bercik P, Falck-Ytter Y, Sultan S, Weizman AV, Morgan RL. AGA Clinical Practice Guidelines on the Role of Probiotics in the Management of Gastrointestinal Disorders. Gastroenterology. 2020 Aug;159(2):697-705. Available at https://www.gastrojournal.org/article/S0016-5085(20)34729-6/fulltext?referrer=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F

    Preidis GA, Weizman AV, Kashyap PC, Morgan RL. AGA Technical Review on the Role of Probiotics in the Management of Gastrointestinal Disorders. Gastroenterology. 2020 Aug;159(2):708-738.e4. Available at: https://pubmed.ncbi.nlm.nih.gov/32531292

    Hempel S, Newberry SJ, Maher AR, Wang Z, Miles JN, Shanman R, Johnsen B, Shekelle PG. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. JAMA. 2012 May 9;307(18):1959-69. Available at: https://jamanetwork.com/journals/jama/fullarticle/1151505

    McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, Dubberke ER, Garey KW, Gould CV, Kelly C, Loo V, Shaklee Sammons J, Sandora TJ, Wilcox MH. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018 Mar 19;66(7):e1-e48. Available at: https://academic.oup.com/cid/article/66/7/e1/4855916