BMJ  2007;335:171 (28 July), doi:10.1136/bmj.39283.396285.1F

Letters

Probiotics and diarrhoea

Data are not widely applicable

We caution against extrapolating the results of Hickson et al, which support the benefit of probiotics in antibiotic associated diarrhoea.¹ We are particularly concerned about their conclusion that a probiotic yoghurt drink, given during and after antibiotic treatment, "has the potential to decrease morbidity, healthcare costs, and mortality if used routinely in patients aged over 50."¹

The magnitude of the protective effects of the probiotic yoghurt against antibiotic associated diarrhoea and Clostridium difficile infection were stark. However, important issues about the study design and conclusions were not considered or given sufficient weighting in the discussion. In particular, the highly selective inclusion and exclusion criteria are crucial in result interpretation. It took over two years to recruit 135 patients out of 1760 screened individuals, and only 113 of these were followed up for evidence of diarrhoea. Put simply, how can data pertaining to less than 7% of a potential target population be extrapolated to routine use?

University of Leeds, Leeds LS1 3EX

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Competing interests: MHW has received honorariums for consultancy work, financial support to attend meetings, and research funding from Astra-Zeneca, Bayer, Genzyme, Pfizer, Vicuron, and Wyeth. JAS has received honorariums for consultancy work and financial support to attend meetings from Novartis and Wyeth.

References

1. 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]

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Relevant Article

Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics: randomised double blind placebo controlled trial

Mary Hickson, Aloysius L D'Souza, Nirmala Muthu, Thomas R Rogers, Susan Want, Chakravarthi Rajkumar, and Christopher J Bulpitt
BMJ 2007 335: 80. [Abstract] [Full Text] [PDF]