Preventing antibiotic associated diarrhoea using a probiotic Lactobacillus Casei preparation

Introduction: There is increasing evidence that probiotics are beneficial in a range of gastrointestinal conditions, including diarrhoea related to antibiotic use.

Therefor the specific objective of this study was to determine the efficacy of a probiotic milk drink containing 6.5×10 9 Lactobacillus casei SHIROTA (Yakult) for the prevention of any diarrhoea associated with antibiotic use and that caused by Clostridium difficile.

Aims & Methods: Patients and methods used: 340 hospital patients (mean age 71) taking antibiotics got a drink containing Lactobacillus casei SHIROTA (Yakult) once a day during a course of antibiotics and for 3 days after the course finished. The control group of 338 patients did not receive a drink containing Lactobacillus casei SHIROTA.

Exclusions included diarrhoea on admission, bowel pathology that could result in diarrhoea, antibiotic use in the previous four weeks. Outcome measures were the occurrence of antibiotic associated diarrhoea and the presence of Clostridium difficile toxin and diarrhoea in both groups.

Results: Our results showed that 17/340 (5%) of the probiotic group developed diarrhoea associated with antibiotic use compared with 63/338 (18%) in the control group (P<0.001, Fisher's exact test). No one in the probiotic group and 21/338 (6%) in the control group had diarrhoea caused by Clostridium difficile ((P<0.0001).

Conclusion: Conclusions: Our data provide clear evidence that consumption of a probiotic milk drink containing 6.5×10 9 Lactobacillus casei SHIROTA (Yakult) once a day can reduce the incidence of antibiotic associated diarrhoea and Clostridium difficile associated diarrhoea highly significantly. This has the potential to decrease morbidity and healthcare costs if used routinely in patients with antibiotic therapy.