Transcript 401_05_probiotics_br..

Use of Probiotics in Larger Controlled Trials in Humans
•Prevention of Diarrhea
•antibiotic associated diarrhea
•infantile diarrhea
•traveler’s diarrhea
•Treatment of Diarrhea
• Clostridium difficile disease
•acute diarrhea - pediatric and adult
D’Souza et al., BMJ 2002;324:1361
Saccharomyces boulardii and Antibiotic Associated
Diarrhea in Hospitalized Patients
N=180; site: University of Washington, Harborview
Hospital
Start
Stop
Stop
Antibioti
Antibioti
Stud
c
c
y
Yeast continued for 14d
Start
Yeast
(withi
n 48h)
Surawicz et al., Gastroenterol. 1989;96:981
Huang, et al., Digestive Diseases and Sciences, Vol.47, No. 11 (Nov 2002)
McFarlan
d et al.,
JAMA;
271,
19131918,
(1994).
S. boulardii & High Dose
Vancomycin for C. difficile Disease
[Results]
60
% CDD recurrences
50%
50
40
*p=0.05
30
20
16.7%
*
10
0
Placeb
o
(n=14)
Surawicz CM. Clin Infect Dis 2000;31:1012-7.
S.
boulardii
(n=18)
Other Uses for Probiotics –Limited Data
•Crohn’s Disease
•Ulcerative Colitis
•Pouchitis
•Allergy/Exema
•Irritable Bowel Syndrome
Dental caries
•High Cholesterol
Urinary Tract Infections
•Helicobacter pylori
• Lactose Intolerance
•Candida vaginal infections
•Bacterial Vaginosis
Table 4. Evidence supporting uses for commercially available (USA) probiotics
Condition
Lactinex
L. reuteri
LGG
S. boulardii
Antibiotic-associated diarrhea
conflicting
?
good
good
C. difficile disease
?
?
limited
good
Traveler’s diarrhea
?
?
fair
fair
Acute diarrhea prevention
(pediatric)
?
?
promising
?
Acute diarrhea treatment
?
good
good
good
Bacterial vaginosis
?
?
?
?
Candida vulvovaginitis
?
?
limited
?
Urinary tract infections
?
?
?
?
From Elmer GW, Am J. Health-Sys Pharmacy 2001;58:1101-1107
Lactobacillus plantum for IBS looks promising
Probiotics Summary
•Living microorganisms with multiple mechanisms of
action
•Good safety profile
•Some applications to prevent and treat infectious diseases
•An alternative to antimicrobials in some situations
•May have other applications, e.g. allergy, colitis
•Product selection is important