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Probiotics prevent Clostridium difficile in people taking antibiotics

BMJ 2012; 345 doi: (Published 20 November 2012) Cite this as: BMJ 2012;345:e7828


Diarrhoea associated with Clostridium difficile is a potentially fatal complication of antibiotic treatment, particularly in older people. Probiotics are an effective prophylactic, according to the latest meta-analysis of clinical trials. In pooled analyses, patients given probiotics were 66% less likely to develop C difficile diarrhoea than were controls given a placebo or no treatment (relative risk 0.34, 95% CI 0.24 to 0.49).

The new meta-analysis updates previous reviews with the inclusion of six extra trials, adding power and precision to previous estimates. The 20 trials had problems with missing data, but results were consistent. The authors say we can be at least moderately confident that probiotics work and prevent an estimated 33 (25 to 38) episodes of C difficile diarrhoea for every 1000 people treated. We can also be moderately confident that they are safe. Controls had significantly more adverse events than patients given probiotics in a pooled analysis of the 17 trials that reported harms.

Most trials tested probiotics in adults who were taking a variety of antibiotics for acute infections. Probiotic preparations included Bifidobacterium, Lactobacillus, Saccharomyces, and Streptococcus spp, alone or in combination. Patients in intervention groups took probiotics for the duration of their antibiotic treatment and for up to two weeks longer.


Cite this as: BMJ 2012;345:e7828

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