Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics:: randomised double blind placebo controlled trial
Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics:: randomised double blind placebo controlled trial
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DOI：
10.1136/bmj.39231.599815.55
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发表时间：
2007-07-14
影响因子：
105.7
通讯作者：
Bulpitt, Christopher J.
中科院分区：
文献类型：
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作者：
Hickson, Mary;D'Souza, Aloysius L.;Bulpitt, Christopher J.
目的探讨含乳酸菌的益生菌饮料预防因抗生素使用而引起的腹泻和艰难梭菌引起的腹泻的疗效。设计随机、双盲、安慰剂对照研究。排除的因素包括入院时腹泻，可能导致腹泻的肠道病理，在过去四周内使用抗生素，严重疾病，免疫抑制，肠道手术，人工心脏瓣膜，以及风湿性心脏病或感染性心内膜炎病史。干预消费100g(97毫升)含有干酪乳杆菌，L保加利亚乳杆菌和嗜热链球菌的饮料，在抗生素疗程期间每天两次，疗程结束后持续一周。安慰剂组接受了长寿无菌奶昔。主要结果指标主要结果：抗生素相关性腹泻的发生。结果益生菌组中有7/57(12%)出现与抗生素使用相关的腹泻，而安慰剂组中有19/56(34%)出现腹泻(P=0.007)。对其他因素进行Logistic回归分析，发现使用益生菌的优势比为0.25(95%可信区间为0.07-0.85)，同时，低白蛋白和低钠也增加了腹泻的风险。绝对风险降低21.6%(6.6%~36.6%)，需要治疗的人数为5人(3~15人)。益生菌组和安慰剂组分别有9/53人(17%)没有艰难梭菌引起的腹泻(P=0.001)。绝对风险降低17%(7%~27%)，需要治疗的人数为6人(4~14人)。结论饮用含有L干酪、L保加利亚和S嗜热菌的益生菌饮料可降低抗生素相关性腹泻和艰难梭菌相关性腹泻的发生率。如果在50岁以上的患者中常规使用，这有可能降低发病率、医疗成本和死亡率。
Objective To determine the efficacy of a probiotic drink containing Lactobacillus for the prevention of any diarrhoea associated with antibiotic use and that caused by Clostridium difficile.Design Randomised double blind placebo controlled study.Participants 135 hospital patients (mean age 74) taking antibiotics. Exclusions included diarrhoea on admission, bowel pathology that could result in diarrhoea, antibiotic use in the previous four weeks, severe illness, immunosuppression, bowel surgery, artificial heart valves, and history of rheumatic heart disease or infective endocarditis.Intervention Consumption of a 100 g (97 ml) drink containing Lactobacillus casei, L bulgaricus, and Streptococcus thermophilus twice a day during a course of antibiotics and for one week after the course finished. The placebo group received a longlife sterile milkshake.Main outcome measures Primary outcome: occurrence of antibiotic associated diarrhoea. Secondary outcome: presence of C difficile toxin and diarrhoea.Results 7/57 (12%) of the probiotic group developed diarrhoea associated with antibiotic use compared with 19/56 (34%) in the placebo group (P=0.007). Logistic regression to control for other factors gave an odds ratio 0.25 (95% confidence interval 0.07 to 0.85) for use of the probiotic, with low albumin and sodium also increasing the risk of diarrhoea. The absolute risk reduction was 21.6% (6.6% to 36.6%), and the number needed to treat was 5 (3 to 15). No one in the probiotic group and 9/53 (17%) in the placebo group had diarrhoea caused by C difficile (P=0.001). The absolute risk reduction was 17% (7% to 27%), and the number needed to treat was 6 (4 to 14).Conclusion Consumption of a probiotic drink containing L casei, L bulgaricus, and S thermophilus reduce the incidence of antibiotic associated diarrhoea and C difficile associated diarrhoea. This has the potential to decrease morbidity, healthcare costs, and mortality if used routinely in patients aged over 50.