More controversy is stirring up about using probiotics in the hospital. Some clinicians advocate using probiotics to help prevent antibiotic-associated diarrhea. For example, giving 12 patients a probiotic seems to prevent one case of antibiotic-associated diarrhea, and giving a probiotic to 29 patients seems to PREVENT one case of C. difficile-associated diarrhea.
Others point to evidence that probiotics (Lacteol-Forte) can reduce necrotizing enterocolitis risk in NICU babies. But recent headlines of a NICU baby dying of mucormycosis due to a contaminated probiotic, remind us that these agents aren't risk free.
And it's not just contamination to worry about. Keep in mind that probiotics are living bacteria or yeast. And there are several reports of patients being infected by the active product. If probiotics are used in your hospital, work with the team to make sure safety is maximized. Educate that the infectious risk seems highest in immunocompromised patients or those with central lines.
If a probiotic powder is used, emphasize infection control measures to keep the powder from becoming airborne or transferred to another patient. Focus on proper hand-washing technique and changing gloves between preparation and administration. For patients taking PO antibiotics, wait at least 2 hours after antibiotic administration to schedule a bacteria-containing probiotic, and do the same with antifungals and S. boulardii-containing products. Read our note, "Continue to expect a limited role for probiotics".
REFERENCES
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Videlock EJ, Cremonini F. Meta-analysis: probiotics in antibiotic-associated diarrhoea. Aliment Pharmacol Ther. 2012 Jun;35(12):1355-69. Available at: https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2012.05104.x
Goldenberg JZ, Ma SS, Saxton JD, Martzen MR, Vandvik PO, Thorlund K, Guyatt GH, Johnston BC. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children. Cochrane Database Syst Rev. 2013 May 31;(5):CD006095. Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006095.pub3/full