In the Hospital? On Antibiotics? Prevent C diff Colitis with This

Clostridium difficile. Nasty stuff. In someone not completely healthy, C diff colitis can kill from the near uncontrollable diarrhea that results.

Otherwise known as C diff, this bacteria is in the Clostridium family.  Siblings you may recognize in this family include Clostridium botulinum (botulism) and Clostridium tetani (tetanus).  Understand that the botulism toxin is one of the most potent toxins on the planet.  A mere thimbleful would be enough to wipe out the entire planet (and yes–this is the same stuff used in Botox–go figure).

C. diff infections occur when antibiotics destroy the normal, protective flora of the intestinal tract and this potentially deadly bacteria can now gain a foothold in the lining of your gut.  As it thrives, it produces toxins that severely irritate the entire GI tract, resulting in diarrhea that can be very difficult to control.  C diff colitis traditionally occurred only in the hospital setting (called hospital-acquired) following the use of broad spectrum antibiotics.  Since this occurs in a population that in which there was already something wrong (they were in the hospital, after all), this can be a very dangerous situation.

That was then, and this is now.  We are seeing an increasing number of community-acquired C diff colitis cases, when people are becoming infected with Clostridium difficile without ever having been in the hospital.  This is a consequence of indiscriminate use of antibiotics in humans and livestock, coupled with lack of recommendations for probiotics to follow up every course of antibiotics.

So what do we do about it?  You guessed it–probiotics.

But, just in case you don’t want to take my word for it, this particular study looked at 20 clinical trials on whether or not probiotics could help prevent or lower the risk of C diff colitis (specifically termed Clostridium difficile–associated diarrhea, or CDAD).   Here’s what they found:

1. Probiotics reduced the incidence of C. diff colitis by 66%. (Tweet this)
2. Using probiotics as a preventative, probiotic prophylaxis would prevent 33 episodes per 1000 persons (keep in mind that statins prevent 11 heart attacks per 1,000).
3. Adverse events in probiotics occurred in 9.3% of patients, compared with 12.6% of control patients.

So across a large number of studies, probiotics clearly lowered the risk of C diff colitis.  No quite an elimination, but a 66% lower risk is not trivial.  Overall, treating everyone on antibiotics with probiotics is a more powerful intervention than is treating patients with statins to prevent a heart attack.  Let’s see if probiotic supplementation to prevent antibiotic associated diarrhea becomes standard practice…

Based on this information, do you think it should be the standard of care for physicians to recommend probiotics along with antibiotics?