One of the most dreaded things we as physicians fear from giving antibiotics is clostridium difficile infection. Clostridium difficile (more commonly known as C diff) is a bacteria that lives harmlessly in the colon of a small percentage of people or may be ingested while people are in a hospital or nursing home. Most of the time C diff does not cause any problems but if you receive antibiotics for any reason you will kill off the normal healthy gut bacteria you have and now C diff can grown unchecked. This can lead to infection of the colon we refer to as pseudomembranous colitis and may even progress to the life threatening condition known as toxic megacolon. It is ironically treated with more antibiotics such as Flagyl or vancomycin. This is an extremely prevalent problem and is increasing not only in frequency but in severity as well. Each year there are tens of thousands of cases of infection due to c diff.
So where do probiotics come in. Well it is logical that if you were to replenish the normal healthy gut bacteria while taking and after taking antibiotics you would eliminate the opportunity for the C diff to grow unchecked. In fact one of the more effective treatments for C diff that often works when antibiotics does not is what is referred to as a stool transplant. This entails taking stool from a family or friend donor and then infusing it into the intestines of the infected person. And this likely works by this mechanism, by taking the healthy bacteria of the donor and putting them into the colon where they can compete with the C diff. And it works, studies show 91 to 93% of the time. And that it is usually only done in cases where antibiotics have failed. Of course it is still not used very often due to the ick factor.
So rather than risk having an infection that can lead to need to have your colon removed or even death or resorting to having your friend’s poop shot up your butt why not just prevent the infection in the first place? Given that it is completely logical that probiotics by replenishing the normal gut flora while on antibiotics could do this and there are basically no side effects that is what I have been doing for the last 3 years and I have yet to have a single case of C diff on my watch ever since I started. Prior to that I cannot count how many of my patients on antibiotics got C diff. Not to mention keeping the gut flora replenished helps reduce gas, bloating and diarrhea caused by antibiotics that is not associated with C diff as well.
There have been lots of small studies and all of them that I have seen have shown a benefit but did not meet statistical signifance due to sample size. A 2006 American Journal of Gastroenterology study by McFarland found 25 randomized controlled trials and did a meta-analysis of them and found a very significant reduction in C diff colitis by using probiotics.
This is a logical treatment, that is cheap and can prevent a serious disease with little or no side effects. That is a win win situation that we rarely see with medications, so there is no reason not to go forward and start studying probiotics for prevention and to help increase the likelihood of cure during treatment of clostridium difficile