John C. Marshall, MD
Does fermented milk with Lactobacillus acidophilus and L. casei prevent antibiotic-associated diarrhea in hospitalized patients?
Randomized, placebo-controlled trial.
Blinded (clinicians and patients).*
21 days after the last antibiotic dose.
A tertiary care hospital in Montreal, Quebec, Canada.
89 hospitalized patients (mean age 71 y, 52% men) who were to take ≥ 3 days of systemic antibiotics. Exclusion criteria were active diarrhea, Clostridium difficile–associated diarrhea in the past 3 months, vancomycin or aminoglycoside treatment, lactose intolerance, underlying chronic gastrointestinal tract disease or stoma, parenteral nutrition or tube feeding, regular use of probiotics, artificial or damaged cardiac valves, and immunocompromised status.
Lactobacilli-fermented milk, combining ≥ 50 x 109 colony-forming units of L. acidophilus CL 1285 and L. casei (Bio-K+ CL 1285, Bio-K+ International Inc, Canada) (n = 44) or a placebo lactoserum devoid of microorganisms (n = 45). Within 48 hours of starting antibiotic treatment, 49 g was initially given once daily for 2 days; then 98 g was given daily until the end of antibiotic treatment.
Antibiotic-associated diarrhea (≥ 3 liquid stools in 24 h). Secondary outcomes were C. difficile–associated diarrhea, length of hospitalization, and adverse events.
100% (intention-to-treat analysis).
Incidence of antibiotic-associated diarrhea was lower in the probiotic group than in the placebo group (Table). Groups did not differ for C. difficile–associated diarrhea, occurrence of ≥ 1 adverse event (Table), or mean duration of hospitalization (12.2 vs 16.4 d; mean difference 4.2 d, 95% CI −1.5 to 9.9).
Fermented milk with Lactobacillus acidophilus and L. casei prevented antibiotic-associated diarrhea in hospitalized patients.
Fermented milk with L. acidophilus and L. casei vs placebo to prevent antibiotic-associated diarrhea in hospitalized patients†
†NS = not significant. Other abbreviations defined in Glossary. RRR, RRI, NNT, NNH, and CI calculated from control event rates and odds ratios in article.
Marshall JC. Daily use of a lactobacilli probiotic prevented antibiotic-associated diarrhea in hospitalized patients. Ann Intern Med. ;149:JC1–10. doi: 10.7326/0003-4819-149-2-200807150-02010
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Published: Ann Intern Med. 2008;149(2):JC1-10.
Diarrhea, Gastroenterology/Hepatology, Hospital Medicine, Infectious Disease.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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