Diarrhoea
Now in the BMJ: Probiotics reduce antibiotic associated diarrhoea
Rijkers G.
A clinical study published 29 June 2007 in the leading British Medical Journal confirms the effectivity of Lactobacillus to reduce the incidence of antibiotic associated diarrhoea. In this study hospitalized patients over 50 years of age, who, according to the authors "are not generally familiar with these products" were given a probiotic containing drink or placebo, starting within 2 days after antibiotic treatment and continuing for 1 week afterwards. Antibiotic associated diarrhoea was reduced from 34% in the control group to 12% in the probiotic group. In the control group 17% tested positive for C. difficile toxin and in the probiotic group none. The authors conclude that in this clinical setting it would cost € 75 to prevent 1 case of C. difficile diarrhoea whereas it costs € 6000 to treat one case.
On the net: BMJ
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Comparative efficacy of dioctahedral smectite (Smecta) and a probiotic preparation in chronic functional diarrhoea
Yao-Zong Y., Shi-Rong L., Delvaux M.
The present study was designed to investigate the clinical efficacy and safety of dioctahedral smectite in Chinese patients with chronic functional diarrhoea and to compare this activity to a probiotic preparation. Patients diagnosed with chronic functional diarrhoea (Rome II criteria), exclusion of blood, ova/parasites in the stool and a normal colonoscopy were included. After a 1-week period of baseline without any medication, they were prescribed three sachets of dioctahedral smectite 3 g, administered 1 h after the meals (Group A), or two capsules of Bifico 210mg (Group B) for 28 consecutive days. Efficacy of the treatments was assessed on frequency of bowel movements and consistency of stool, as compared to baseline. Four hundred and ten patients were included (258 males, 152 females; mean age 43.8+/-13.9 years): 208 in Group A and 202 in Group B. In Group A, the mean number of stool per day decreased from 3.5+/-1.0 at baseline to 2.0+/-0.9 and from 3.3+/-1.0 to 2.2+/-0.9 in Group B (z = 2.699; P = 0.007). Decrease in stool number was significant with both treatments but more important with smectite at week 2 and remained significant throughout the treatment period. Stool consistency, assessed by the Bristol scale, also improved significantly over the treatment period, as compared to baseline (z = 3.310, P = 0.001). Dioctahedral smectite appeared in this study to be an effective and safe treatment of chronic functional diarrhoea, its effect starting during the first week of treatment and consisting in a decrease in the frequency of daily bowel movements and improvement of stool consistency. Moreover, dioctahedral smectite displays a prolonged action after disruption of the treatment that may interfere with the natural course of the disease.
Dig Liver Dis. 2004 Dec;36(12):824-8.
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Probiotics for treating infectious diarrhoea
Allen S.J., Okoko B., Martinez E., Gregorio G., Dans L.F.
Probiotics are microbial cell preparations or components of microbial cells that have a beneficial effect on the health and well being of the host. Probiotics may offer a safe intervention in acute infectious diarrhoea to reduce the duration and severity of the illness.
OBJECTIVES: To assess the effects of probiotics in proven or presumed infectious diarrhoea.
SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group's trials register (December 2002), the Cochrane Controlled Trials Register (The Cochrane Library Issue 4, 2002), MEDLINE (1966 to 2002), EMBASE (1988 to 2002), and reference lists from studies and reviews. We also contacted organizations and individuals working in the field, and pharmaceutical companies manufacturing probiotic agents.
SELECTION CRITERIA: Randomized controlled trials comparing a specified probiotic agent with placebo or no probiotic in people with acute diarrhoea that is proven or presumed to be caused by an infectious agent.
DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial methodological quality and extracted data.
MAIN RESULTS: Twenty-three studies met the inclusion criteria with a total of 1917 participants, mainly in countries with low overall mortality rates. Trials varied in relation to the probiotic(s) tested, dosage, methodological quality, and the diarrhoea definitions and outcomes.Probiotics reduced the risk of diarrhoea at 3 days (relative risk 0.66, 95% confidence interval 0.55 to 0.77, random effects model; 15 studies) and the mean duration of diarrhoea by 30.48 hours (95% confidence interval 18.51 to 42.46 hours, random effects model, 12 studies). Subgroup analysis by probiotic(s) tested, rotavirus diarrhoea, national mortality rates, and age of participants did not fully account for the heterogeneity.
REVIEWERS' CONCLUSIONS: Probiotics appear to be a useful adjunct to rehydration therapy in treating acute, infectious diarrhoea in adults and children. More research is needed to inform the use of particular probiotic regimens in specific patient groups.
Cochrane Database Syst Rev. 2004(2):CD003048.
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