Health In Focus
  • Use of antibiotics is known to be one of the major risk factors for causing Clostridium difficile associated diarrhea (CDAD)
  • Probiotics, when used as preventive therapy, may reduce the occurrence of Clostridium difficile associated diarrhea (CDAD)
  • Side effects of the associated disease are compared with control groups and found to be reduced significantly

Clostridium difficile is a Gram-positive, spore-forming bacterium which is found to cause the diarrheal illness in patients receiving antibiotics. The infection spreads via the fecal-oral route. Probiotics are the live organisms which counteract the disturbances in the gut microbial balance associated with the use of antibiotics. Probiotics also minimize the risk of colonization of pathogenic bacteria in the gut.

Probiotics use in Clostridium difficile-associated Diarrhea (CDAD)

Clostridium difficile infection is found to be the primary cause of antibiotic-associated diarrhea. The incidence of the antibiotic-associated gastrointestinal illness has increased recently over the past decades with a great burden in the healthcare system. Several randomized clinical trials were conducted which involved more than 8500 patients. The patients were studied to evaluate the effectiveness of probiotics in CDAD. The studies involved all groups of inpatient and outpatient settings including both adults and children.
Probiotics may Prevent Clostridium Difficile-associated Diarrhea's Occurrence

Preventive therapy of probiotic supplementation was found to minimize the occurrence of CDAD in patients taking antibiotics. Adverse effects such as fever, nausea, abdominal cramps, flatulence, and taste disturbances were also found to be greatly reduced, and no episodes of severe probiotic-associated side effects such as fungemia or bacteremia were reported while taking probiotic supplements.

Probiotics with a dose of 20 to 50 billion colony forming units can be prescribed daily to hospitalized patients who are given antibiotics to prevent CDAD. The probiotic supplementation should be started within 48 hours, once the antibiotic treatment has been initiated.

Common antibiotics associated with the cause of CDAD

  • Penicillins
  • Cephalosporins
  • Fluoroquinolones (e.g., Ciprofloxacin, Levofloxacin)
  • Clindamycin

What are the other risk factors for Clostridium difficile-associated diarrhea?

  • Immunosuppressive treatments
  • Elderly age
  • Use of nasogastric tubes
  • An extended stay in a hospital
  • Admitted to intensive care units
  • Serious underlying diseases
  • Sharing room with Clostridium difficile patients
  • Recent surgical procedures

When should you not take Probiotics?

  • Patients with low immune function or immunodeficiency
  • Patients admitted to intensive care units
  • History of gastrointestinal disorders (Inflammatory bowel disease)
  • Ostomy (Surgical opening between the intestine and abdominal wall)
  • Implantation of prosthetic heart valves
  • Pregnancy
  • While on central venous catheters
  • Premature infants
References :
  1. Do Probiotics Prevent C. difficile -Associated Diarrhea in Patients Receiving Antibiotics? - ( associated-diarrhea)
  2. Clostridium difficile-Associated Diarrhea - (
  3. Probiotics are effective at preventing Clostridium difficile-associated diarrhea: A systematic review and meta-analysis - ( associated_diarrhea_A_systematic_review_and_meta-analysis)
  4. Probiotic - (

Source: Medindia

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