No high risk antibiotics?

doi:10.1136/bmj.39283.421007.1F

BMJ 2007;335:171 (28 July), doi:10.1136/bmj.39283.421007.1F

Letters

Probiotics and diarrhoea

No high risk antibiotics?

The first 100% of the full text of this article appears below.

I was astounded to read in the study method that Hickson etal had excluded "high risk" antibiotics (as well as some misclassifiedlow risk antibiotics).¹ To do so is akin to performing a trialof an agent that claims to prevent type 2 diabetes, but excludingobese patients.

Cephalosporins in particular are rapidly losing their usefulnessas frontline antimicrobial agents because of their potentialto cause Clostridium difficile associated diarrhoea. The lossof these highly effective agents cannot be a good thing.

Any therapy that has the potential to reduce the incidence ofdiarrhoea associated with C difficile should be investigatedwith enthusiasm, but it should be done in a meaningful way.To exclude the very people in whom it is particularly importantto prevent such diarrhoea—patients taking high risk antibiotics—makesthis trial of academic value only.

Tom Billyard, Foundation year 2 doctor

University Hospitals Coventry and Warwickshire, Coventry CV2 2DX

tbillyard@doctors.org.uk

Competing interests: None declared.

Hickson M, D'Souza AL, Muthu N, Rogers TR, Want S, Rajkumar C, et al. Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial. BMJ 2007;335:80-3. (14 July.)[Abstract/Free Full Text]