This week, I was at a conference in Cambridge that looked at the transfer of nutrition knowledge into practice – and of course, as a QCS contributor, my interest was drawn to a presentation that looked at the use of probiotics in care homes, particularly in relation to antibiotic associated diarrhoea.
Antibiotic associated diarrhoea
Care home residents are prescribed more antibiotics than the general population; in comparison, they generally have a higher risk of infection, reduced immunity and a number of health conditions (multimorbidity). With higher antibiotic usage, there is an associated high prevalence of antibiotic-associated diarrhoea (AAD) in older care home residents.
Antibiotic treatment may disturb the balance of the microorganisms that normally inhabit the gut which can result in a range of symptoms, most notably, diarrhoea with Clostridium difficile recognized as a major cause. Clostridium difficile may colonise the gut if the normal healthy balance has been disturbed.
Diarrhoea causes a substantial burden on lives of the frail elderly and significantly reduces the quality of life and treatment of diarrhoea increase costs in healthcare.
Where may probiotics be useful?
Probiotics found in, for example, dairy style fermented drinks and as supplements, are live bacteria that are thought to be beneficial for health, possibly by increasing the ‘good’ bacteria and reducing ‘bad’ bacteria (potentially harmful) in the gut. If probiotics can restore the balance of ‘good’ bacteria in the gut then, in theory, they could possibly be used to treat/prevent diarrhoea, including AAD.
Could probiotics given with antibiotics reduce the risk of developing AAD?
Research indicates that probiotics do show potential in the treatment of AAD and infectious diarrhoea. A systematic review, pooling together the results of trials that used a variety of probiotic bacterial strains in limited numbers of adults and children, provided evidence to support a protective effect in preventing AAD and Clostridium Difficile Associated Diarrhoea (CDD). Importantly probiotics appear to be safe and effective.
However robust evidence to substantiate probiotic use as standard practice is still lacking. For example, a large well-conducted trial showed no evidence that a multistrain probiotic preparation was effective in the prevention of AAD or CDD. It may be argued rightly or wrongly, that the wrong strains were chosen or that another strain would be better. What such trials demonstrate is that we still need more high-quality trials to identify optimal strains and dosages, as well as the optimal length of probiotic treatment in relation to each antibiotic class. More studies specifically in care home populations are also needed, and safety in the most vulnerable frail and immunocompromised service users should always be assessed.
So some studies have shown probiotics to be effective at reducing infections but research in care home residents is currently still lacking. We need more to be able to give clearer recommendations.