Probiotics and… Ahem, Diarrhea

6a00e55255b4628834017eea943b50970d-200wiFor nearly 3 decades, my colleagues in the world of Integrative Medicine and Holistic medicine have been warning about the consequences of excessive antibiotic use, calling for the use of more probiotics and other measures to prevent the consequences of antibiotic use in the digestive system, including yeast overgrowth.

Protocols suggested include probiotics as the foundation for treatment of gut issues. Use of probiotics by physicians for problems associated with antibiotics goes back much further than our three decades, but during the recent 30 years or so, probiotics use seems to have been forgotten by the majority of doctors practicing in this country.

The traditional medical establishment seems to have rediscovered probiotics an article printed in JAMA (The Journal of the American Medical Association)–at least for the condition of diarrhea, which would be a more obvious manifestation of antibiotic overgrowth of yeast and other resistant organisms.

I welcome this study in a popular journal, even though it lacks a prominent mention of the possible relationship to yeast overgrowth from antibiotic use and the other synergistic measures that would help with this problem. Perhaps someday, integrative physicians like myself will be recognized as clinical pioneers than as quacks. And to the authors of the article who have recently explored this treatment, I must add, “You don’t say; what a surprise!”

 I’ve included the abstract from the study below.

To your health,

-Dr. Alan M. Dattner, MD


JAMA. 2012;307(18):1959-1969. doi: 10.1001/jama.2012.3507
Probiotics for the Prevention and Treatment of Antibiotic-Associated Diarrhea

A Systematic Review and Meta-analysis

.                Susanne Hempel, PhD; Sydne J. Newberry, PhD; Alicia R. Maher, MD; Zhen Wang, PhD; Jeremy N. V. Miles, PhD; Roberta Shanman, MS; Breanne Johnsen, BS; Paul G. Shekelle, MD, PhD
[+] Author Affiliations
.                Author Affiliations: Southern California Evidence-based Practice Center, RAND Health, Santa Monica (Drs Hempel, Newberry, and Shekelle, and Ms Shanman and Ms Johnsen); RAND, Santa Monica (Drs Maher, Wang, and Miles); West Los Angeles VA Medical Center, Los Angeles (Dr Shekelle); and Cedars-Sinai Medical Center, Los Angeles (Dr Maher), California.


Context Probiotics are live microorganisms intended to confer a health benefit when consumed. One condition for which probiotics have been advocated is the diarrhea that is a common adverse effect of antibiotic use.

Objective To evaluate the evidence for probiotic use in the prevention and treatment of antibiotic-associated diarrhea (AAD).

Data Sources Twelve electronic databases were searched (DARE, Cochrane Library of Systematic Reviews, CENTRAL, PubMed, EMBASE, CINAHL, AMED, MANTIS, TOXLINE, ToxFILE, NTIS, and AGRICOLA) and references of included studies and reviews were screened from database inception to February 2012, without language restriction.

Study Selection Two independent reviewers identified parallel randomized controlled trials (RCTs) of probiotics (Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and/or Bacillus) for the prevention or treatment of AAD.

Data Extraction Two independent reviewers extracted the data and assessed trial quality.

Results A total of 82 RCTs met inclusion criteria. The majority used Lactobacillus -based interventions alone or in combination with other genera; strains were poorly documented. The pooled relative risk in a DerSimonian-Laird random-effects meta-analysis of 63 RCTs, which included 11 811 participants, indicated a statistically significant association of probiotic administration with reduction in AAD (relative risk, 0.58; 95% CI, 0.50 to 0.68; P < .001; I2, 54%; [risk difference, −0.07; 95% CI, −0.10 to −0.05], [number needed to treat, 13; 95% CI, 10.3 to 19.1]) in trials reporting on the number of patients with AAD. This result was relatively insensitive to numerous subgroup analyses. However, there exists significant heterogeneity in pooled results and the evidence is insufficient to determine whether this association varies systematically by population, antibiotic characteristic, or probiotic preparation.

Conclusions The pooled evidence suggests that probiotics are associated with a reduction in AAD. More research is needed to determine which probiotics are associated with the greatest efficacy and for which patients receiving which specific antibiotics.



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