BMJ 2002;325:901 ( 19 October )

Letters

Probiotics and antibiotic associated diarrhoea

    Lactulose is effective
    The case for probiotics remains unproved
    Authors' reply

Lactulose is effective

The first 150 words of the full text of this article appear below.

EDITOR---D'Souza et al evaluated potential agents for the prevention of antibiotic associated diarrhoea, whose full spectrum of activity is immense both in the community and in hospital.1 In particular, the antitherapeutic default selection of Clostridium difficile with resultant colitis is associated with a considerable morbidity and mortality.

Alteration of the faecal flora is attractive as a low risk means of preventing or, possibly, treating C difficile and associated infections.2 Induced disequilibrium of the colonic flora can be achieved either through supplemental probiotic loading or by therapeutic manipulation. Faecal flora can be manipulated through the use of lactulose, a synthetic disaccharide that is predominantly used as an osmotic laxative. It is neither absorbed nor metabolised in the upper gastrointestinal tract but is degraded by the bacterial flora of the proximal colon to organic acids. These acidify the proximal colon and result in a dose dependent catharsis.

Lactulose has several . . . [Full text of this article]
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Relevant Article

Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis
Aloysius L D'Souza, Chakravarthi Rajkumar, Jonathan Cooke, and Christopher J Bulpitt
BMJ 2002 324: 1361. [Abstract] [Full Text] [PDF]

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