Probiotics for treatment of Clostridium difficile-associated colitis in adults

  • Review
  • Intervention

Authors


Abstract

Background

Probiotics are live microorganisms consisting of non-pathogenic yeast and bacteria that are believed to restore the microbial balance of the gastrointestinal tract altered by infection with Clostridium difficile (C. difficile).

Objectives

To assess the efficacy of probiotics in the treatment of antibiotic associated C. difficile colitis.

Search methods

The databases MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and Cochrane IBD/FBD Specialized Trials register were searched to locate all published reports from 1966 to 2007.

Selection criteria

Randomized, prospective studies using probiotics alone or in conjunction with conventional antibiotics for the treatment of documented C. difficile colitis were eligible for inclusion.

Data collection and analysis

Data extraction and analysis was done independently by two authors.

Main results

Four studies met the inclusion criteria and were included in the review. The four studies examined the use of probiotics in conjunction with conventional antibiotics (vancomycin or metronidazole) for the treatment of recurrence or an initial episode of C. difficile colitis in adults. The studies were small in size and had methodological problems. A statistically significant benefit for probiotics combined with antibiotics was found in one study. McFarland 1994 found that patients receiving S. boulardii were significantly less likely than patients receiving placebo to experience recurrence of C. difficile diarrhea (RR 0.59; 95% CI 0.35 to 0.98). No benefit of probiotics treatment was found in the other studies.

Authors' conclusions

There is insufficient evidence to recommend probiotic therapy as an adjunct to antibiotic therapy for C. difficile colitis. There is no evidence to support the use of probiotics alone in the treatment of C. difficile colitis.

摘要

背景

益生菌對於成人梭狀芽孢桿菌(Clostridium difficile)相關的結腸炎之治療

益生菌是含有非病原性酵母菌和細菌的活微生物,被認為對於因為感染梭狀芽孢桿菌而改變的胃腸道之微生物平衡有復原的功能。

目標

評估益生菌對於治療梭狀芽孢桿菌相關的腸炎之療效。

搜尋策略

我們搜尋自1966年到2007年在MEDLINE,EMBASE, Cochrane Central Register of Controlled Trial和Cochrane IBD/FBD Specialized Trials 的所有發表的報告

選擇標準

選擇單獨使用益生菌或合併傳統抗生素治療已證實的梭狀芽孢桿菌腸炎之隨機和前瞻性的研究。

資料收集與分析

兩名作者獨立地做資料的選取和分析。

主要結論

有4個研究符合選擇標準並且被歸入回顧分析。這4個研究是檢驗使用益生菌合併傳統抗生素(vancomycin或metronidazole)治療成人復發或剛發病的梭狀芽孢桿菌腸炎的情形。這些研究的樣本較少而且有方法學上的問題。在一項研究發現益生菌合併抗生素在統計學上有助益。在1994 McFarland發現病患接受S。boulardii比接受安慰劑的病患有明顯較不會發生梭狀芽孢桿菌腹瀉復發的情形(RR 0.59; 95% CI 0.35 to0.98)。除此,沒有研究發現益生菌治療的好處。

作者結論

建議益生菌當做抗生素治療梭狀芽孢桿菌結腸炎的輔助療法的證據是不足的。沒有證據支持單獨使用益生菌治療梭狀芽孢桿菌結腸炎。

翻譯人

本摘要由臺中榮民總醫院王建得翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

益生菌等同活微生物,在治癒梭狀芽孢桿菌感染是一個未證實的抗生素替代或添加物。在使用抗生素於不相關疾病的病人,梭狀芽孢桿菌會附著上腸道壁,引起嚴重腹瀉,有時會導致死亡。抗生素會消滅腸道中所謂“好”的或是有保護力的細菌,以致於導致梭狀芽孢桿菌滋生。益生菌是類似保護腸道的細菌之類的酵母菌和細菌,而且在幾個研究中已被使用來治療梭狀芽孢桿菌感染。不幸地是這些小型的研究無法提出足夠證據支持使用益生菌來治療梭狀芽孢桿菌感染。

Plain language summary

Probiotics for treatment of Clostridium difficile -associated colitis in adults

Clostridium difficile (C. difficile) is a bacterium that attaches itself to the gut wall and is responsible for causing severe diarrhea and sometimes death in patients who have undergone antibiotic therapy for unrelated diseases. Antibiotics tend to wipe out the "good" or protective bacteria in the gut which allows colonization with C. difficile. Probiotics are bacteria and yeasts that resemble the protective bacteria of the gut and have been used in several studies to treat C. difficile infection. Unfortunately, these small studies do not provide enough evidence to support the use of probiotics for treating C. difficile infection.

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