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Medical use of probiotics can significantly minimize C. difficile (Clostridium difficile) infection among hospitalized patients taking antibiotics, say researchers at the University of Toronto.

“Minimizing or even preventing C. difficile among vulnerable patients is a high priority for making every hospital as safe as possible," says Professor Bradley Johnston of U of T's Institute of Health Policy, Management & Evaluation and Scientist and Clinical Epidemiologist at The Hospital for Sick Children (SickKids). "It’s an important public health issue."

In a study recently published in Annals of Internal Medicine, researchers from SickKids and McMaster University compiled findings from 20 randomized controlled trials including a total of 3,818 patients. The trials tracked rates of probiotic use in inpatients and outpatients who were receiving antibiotics, and analyzed rates of diarrheal illness associated with C. difficile among the groups.

Overall, use of probiotics reduced the new cases of C. difficile-associated diarrhea by two thirds (66 per cent), with no serious adverse events attributable to probiotics.

"Probiotics are not a magic bullet, but these results suggest that therapeutic probiotic agents, as well as some yogurts and probiotic dairy products, may be vastly under-used in some nursing homes and hospitals,” says Johnston.

The risk of serious C. difficile infection appears primarily among older hospitalized adults who are exposed to antibiotics. Up to half of all diarrheal illness in hospital is associated with this infection, which is a significant cause of illness and death in hospitalized adults. From 2009-2011 the Ontario Ministry of Health and Long-Term Care tracked 75 outbreaks in 47 hospitals.

Because immunocompromised and debilitated children are potentially at risk of systemic infection from probiotics, more research is needed regarding application of these results to children.

“Although this study found no serious adverse events among the populations studied, we need further research into the significance of the results and the safety and efficacy of probiotics in children, notably those with weakened immune systems,” says Professor Upton Allen (Department of Paediatrics and Institute of Health Policy, Management and Evaluation) Chief, Division of Infectious Diseases, and Senior Associate Scientist at SickKids.

Probiotic powder and capsules as well as yogurt were included in the studies analyzed.

“The results appeared to be even more pronounced when several probiotic organisms were used together,” says Johnston.

When broad-spectrum antibiotics are prescribed to treat and prevent infections the medications can also destroy necessary bacteria in the colon. Probiotics help to reintroduce healthy bacteria.

“That’s why probiotics could be an effective, safe and relatively inexpensive approach to prevent C. difficile-associated diarrheal illness in adult patients whose immune systems are not compromised,” says Johnston.