Infection Prevention by Gonzalo Bearman Silvia Munoz-Price Daniel J. Morgan & Rekha K. Murthy

Author:Gonzalo Bearman, Silvia Munoz-Price, Daniel J. Morgan & Rekha K. Murthy
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Guidelines for Use of Probiotics for Primary C. difficile Prevention

Currently, national guidelines do not recommend probiotics to prevent initial episodes of C. difficile. The 2010 SHEA/IDSA guidelines advise against prescribing probiotics for primary C. difficile prevention [31], and the 2013 American College of Gastroenterology guidelines state there is insufficient evidence to recommend probiotics for primary prevention [32].

Probiotics for Secondary Prevention of C. difficile

Probiotics may be more effective for secondary prevention of recurrent CDI, once C. difficile-associated dysbiosis has occurred, than for primary prevention. Approximately one third of patients who develop CDI will later suffer from recurrent CDI [31], and these infections are not only more challenging to treat but can be drastically more expensive. The estimated cost per case for primary CDI is $5243, in comparison to $13655 per case for recurrent CDI [33].

In 1994, McFarland et al. studied the effect of S. boulardii for prevention of recurrent CDI in a randomized double-blind, placebo-controlled multicenter trial and found a significant reduction in later recurrent episodes when given in combination with standard antibiotics to treat C. difficile. However, antibiotic therapy, dosage, and duration were not controlled [34]. In 2000, Surawicz et al. expanded upon this research by performing a randomized double-blind, placebo-controlled trial with S. boulardii for prevention of recurrent CDI while controlling antibiotic therapy. Participants, who were randomized to high- or low-dose vancomycin or metronidazole, received S. boulardii or placebo starting on day 7 of antibiotic therapy and continuing for 28 days. S. boulardii effectively decreased both the frequency and number of CDI recurrences at 8 weeks in the patients who received high-dose vancomycin but not in those who received low-dose vancomycin or metronidazole [35].

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