The Bottom Line: Moderate-quality evidence supports a significant protective effect of probiotics against CDAD, and higher-risk patients (e.g. patients with prior history of CDAD) stand to benefit more from prevention. Probiotics should not be given to patients who are immunocompromised, are pregnant, are in intensive care, or have prosthetic heart valves or certain preexisting gastrointestinal disorders (e.g., inflammatory bowel disease, ostomy). For most other hospitalized patients who receive antibiotics during hospitalization, prescribing 20 to 50 billion colony forming units of probiotics daily (starting within 24–48 hours of antibiotic initiation) can prevent CDAD (Dressler, 2017).
References: Dressler DD. Do probiotics prevent C. difficile-associated diarrhea in patients receiving antibiotics? NEJM Journal Watch. 2018 Mar 13.
Goldenberg JZ, Yap C, Lytvyn L, Lo CK, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children. Cochrane Datbase Syst Rev. 2017 Dec 19;12:CD006095.
Summary: In summarizing their systematic review, Goldenberg et al (2017) state:
“This review includes 39 randomized trials with a total of 9955 participants. Thirty-one studies (8672 participants) assessed the effectiveness of probiotics for preventing CDAD among those taking antibiotics. Our results suggest that when probiotics are given with antibiotics the risk of developing CDAD is reduced by 60% on average. Among trials enrolling participants at high risk of developing CDAD (>5%), the potential benefit of probiotics is more pronounced with a 70% risk reduction on average. Side effects were assessed in 32 studies (8305 participants) and our results suggest that taking probiotics does not increase the risk of developing side effects. The most common side effects reported in these studies include abdominal cramping, nausea, fever, soft stools, flatulence, and taste disturbance.”