Probiotics actually can reduce diarrhea related to antibiotic use, a study in this week's JAMA concludes. Wow! As I opine in this week's YouTube, and as Rick and I conclude in PodMed, looks like Mom was right when she advised yogurt consumption to avoid this particular problem. And just in time for Mother's Day. Even better.
So let's start with some background. Turns out that about 30% of people who must take antibiotics for a variety of infections develop diarrhea, sometimes severe diarrhea, and this is also an important determinant for non-compliance with therapy. For some time, of course, so-called probiotics have been touted as the method for coping with this problem, and a host of other problems, btw. Yet what has clearly emerged as probiotics have been studied rigorously is that a) gut flora is incredibly complicated b)modifying gut flora via oral administration of single bacterial cultures or mixtures may or may not significantly impact on changing the gut flora c) normal gut flora is challenging to study because recreating gut conditions in a laboratory environment is technically difficult, and d) one's gut flora changes secondary to a number of factors, including diet, where and with whom one is living, and health conditions. So no wonder that establishing a clear benefit from probiotics has been difficult, and add to that the fact that makers of probiotics have had a clear profit motive , thus rendering their claims suspicious.
So where does this study take us? This is a meta-analysis of 63 randomized, controlled trials of the use of probiotics when antibiotics were also taken. The usual bacterium was Lactobacillus, the self-same organism used to produce the majority of yogurt. While each of the specific studies included were small and the reporting methods sometimes suboptimal, the final analysis included data from almost 12,000 participants. The study concluded that use of probiotics was able to reduce the risk of developing diarrhea secondary to antibiotic use by 42%.
Here's what we like about this study: it suggests that a self-administered, low-risk, and low-cost strategy for avoiding one common side effect of antibiotic use works. And there's no need to consume specialized concoctions, it's most likely that the store-brand, lowly yogurt will do the trick. As Rick points out in the podcast, there are a number of questions this analysis doesn't have the power to answer, including dosing data, but it seems reasonable to conclude that patients can try this safely at home.
Other topics this week include two from the Lancet: Millennium villages and their very positive impact on child mortality in Africa, and the worldwide burden of infection-related cancers, and substituting fruit for fruit juice in the diet of young people in Archives of Pediatrics and Adolescent Medicine. Until next week, y'all live well.