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

BMJ. 2007 Jul 14;335(7610):80.

Hickson M, D'Souza AL, Muthu N, Rogers TR, Want S, Rajkumar C, Bulpitt CJ.

Hickson and colleagues (2007) undertook a randomized, placebo-controlled study of 135 elderly, hospitalized patients taking antibiotics to determine the impact of a probiotic-containing fermented milk on the incidence of antibiotic associated diarrhea and diarrhea associated with C. difficile toxins (A and/or B). Although the study authors indicate the study was double blinded, the placebo and test products could be distinguished due to dispensing in different size bottles (200 ml bottles for placebo and 100 ml bottles for the active product). The study was conducted with patients from three London UK hospitals. The probiotic product, Actimel (equivalent to the product called “DanActive” in the USA), contained L. casei DN-114 001 (aka L casei imunitass), S. thermophilus and L. bulgaricus. The total daily dose was 20 billion each of the L. casei and S. thermophilus strains and 2 billion of the L. bulgaricus. The intervention was started within 48 hrs of the start of antibiotic treatment and continued until one week after antibiotic treatment ended. Compliance with the probiotic drink was good. Seven of 57 patients in the probiotic group compared to 19 of 56 in the placebo group had diarrhea during the study. None of diarrhea in the probiotic group was associated with C. difficile. The authors concluded that Actimel “has the potential to decrease morbidity, healthcare costs, and mortality if used routinely in patients aged over 50.”