College of Pharmacy
In this section
HelixTalk Episode #73 - Don’t go with the flow: how antibiotics cause diarrhea and what you can do about it
Date posted: January 30, 2018, 6:00 am
In this episode, we discuss the efficacy and safety of probiotics for the prevention of antibiotic-associated diarrhea (AAD) and Clostridium difficile-associated diarrhea (CDAD).
- All antibiotics can cause diarrhea, but certain antibiotics are much more prone to this adverse effect than others, such as amoxicillin/clavulanate, cefixime, and clindamycin.
- All antibiotics can cause Clostridium difficile-associated diarrhea. Clindamycin is by far the worst culprit (and has a boxed warning just for this risk).
- Probiotics almost certainly decrease the risk of antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea, but the data supporting this benefit is extremely heterogeneous. There is not one single, large randomized controlled trial demonstrating benefit, but instead is supported by meta-analyses.
- There is no clear probiotic strain, dose, or duration that has convincingly shown benefit versus another regimen. More expensive probiotic preparations are not necessarily better.
- If probiotics are initiated to prevent antibiotic-associated diarrhea, initiate the probiotic as soon as possible (ideally even before the first antibiotic dose).
- Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis. JAMA. 2012 May 9;307(18):1959-69.
- Shen NT, Maw A, Tmanova LL, et al. Timely Use of Probiotics in Hospitalized Adults Prevents Clostridium difficile Infection: A Systematic Review With Meta-Regression Analysis. Gastroenterology. 2017 Jun;152(8):1889-1900.e9.
- Allen SJ, Wareham K, Wang D, et al. Lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and Clostridium difficile diarrhoea in older inpatients (PLACIDE): a randomized, double-blind, placebo-controlled, multicentre trial. Lancet. 2013 Oct 12;382(9900):1249-57.