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LETTERS:
P J Sanderson, B Allaouchiche, H Jaumain, D Chassard, Daryl Leung, Roberto D'Amico, Silvia Pifferi, and Alessandro Liberati
Effectiveness of antibiotic prophylaxis in critically ill patients
BMJ 1998; 317: 1526a [Full text]
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[Read Rapid Response] PROPHYLACTIC USE OF PROBIOTIC ENRICHED YOGURT
Aparna Uppaluri   (23 January 1999)

PROPHYLACTIC USE OF PROBIOTIC ENRICHED YOGURT 23 January 1999
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Aparna Uppaluri,
Research Associate, Medical Surveillance for Inactive Tuberculosis
University of Toronto, Toronto, Ontario, Canada

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Re: PROPHYLACTIC USE OF PROBIOTIC ENRICHED YOGURT

Hospitalized patients are at an increasing risk to develop infections (1). Antibiotics used in the management of infections could disrupt normal gut flora (2). These factors facilitate overgrowth of harmful bacteria. Onece colonized toxigenic Clostridium difficile (CD) bacteria release toxins and cause the intestinal disease (2). Besides antibiotics, other factors such as break in aseptic precautions do play a role in the causation of CD disease. Manian et al have reported that unsuspected contaminated blood pressure cuffs have been responsible for an outbreak of CD associated diarrhea (3). Besides, the need for effective infection- control strategies to tackle the CD disease, a novel idea of using probiotic bacteria such as Lactobacillus acidophilus appears attractive. The probiotic bacteria have the potential to restore the natural gut flora and combat the colonization of the harmful pathogenic bacteria such toxigenic CD (4).

In the retrospective study at a long-term care facility, Chennapragada et al (5) have shown a significant reduction in the incidence of CD diarrhea when probiotic (Lactobacillus acidophilus) enriched yogurt was administered along with antibiotic therapy. It is time more randomized trials are carried out to establish the evidenced based prophylactic role of the probiotics. Yogurt with live cultures of Lactobacillus acidophilus is readily available in the food market and has the potential to prevent CD diarrhea at a low cost and minimal risk.

References:

1. D'Amico R, Pifferi S, Leonetti C et al. Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomized trials. BMJ 1998; 316:1275-1285

2. Kelly B S et al. Clostridium difficile colitis. N Engl J Med. 1994; 330: (4) 257 –267.

3. Manian FA, Meyer L, Jenne J. Clostridium difficile contamination of blood pressure cuffs: a call for a closer look at gloving practices in the era of universal precautions. Infect Control Hosp Epidemiol 1996 Mar; 17(3): 180-2

4. Lidbeck A. Nord CE. Lactobacilli and the normal human anaerobic microflora. Clin Infect Dis. 1993; 16 Suppl.4: S181-7.

5. Chennapragada K, Bhaskarabhatla V M K, Green M et al. The effect of yogurt in reducing antibiotic associated clostridium difficile diarrhea at a long-term care facility. Abst: J Am Geriatr Soc. 1998; 46:S.83