[Show abstract][Hide abstract] ABSTRACT: Perturbation of bacterial microflora of the gastrointestinal (GI) tract may play an important role in the pathophysiology of some GI disorders. Probiotics have been used as a treatment modality for over a century. They may restore normal bacterial microflora and effect the functioning of the GI tract by a variety of mechanisms. Probiotics are not currently regulated and only few randomized controlled trials exist investigating their efficacy in different GI disorders. They are available in a variety of formulations and delivery systems making interpretation and comparison of studies even more difficult. The efficacy of probiotics, either as a single strain or a combination of probiotics, has been tested in antibiotic-associated diarrhea, Clostridium difficile colitis, infectious diarrhea, ulcerative colitis, Crohn's disease, pouchitis, and irritable bowel syndrome, among other disorders. Results of the studies are reviewed in this article and recommendations for probiotic use in these disorders are made. Although probiotics appear to be generally safe in an outpatient setting, the situation may be different in immunocompromised, hospitalized patients who may be at a greater risk of developing probiotic sepsis. No studies exist addressing the issue of safety specifically. Many questions regarding use of probiotics in GI disorders remain to be answered in future studies, such as most optimal doses, duration of treatment, physiological and immunological effects, efficacy of specific probiotics in specific disease states, and safety in debilitated patients.
Therapeutic Advances in Gastroenterology 09/2010; 3(5):307-19.
[Show abstract][Hide abstract] ABSTRACT: Antibiotic-associated diarrhea (AAD) is a common complication of antibiotic use. There is growing interest in probiotics for the treatment of AAD and Clostridium difficile infection because of the wide availability of probiotics. The aim of this multicenter, randomized, placebo-controlled, double-blind trial was to assess the efficacy of probiotic Lactobacillus (Lacidofil® cap) for the prevention of AAD in adults. From September 2008 to November 2009, a total of 214 patients with respiratory tract infection who had begun receiving antibiotics were randomized to receive Lactobacillus (Lacidofil® cap) or placebo for 14 days. Patients recorded bowel frequency and stool consistency daily for 14 days. The primary outcome was the proportion of patients who developed AAD within 14 days of enrollment. AAD developed in 4 (3.9%) of 103 patients in the Lactobacillus group and in 8 (7.2%) of 111 patients in the placebo group (P=0.44). However, the Lactobacillus group showed lower change in bowel frequency and consistency (50/103, 48.5%) than the placebo group (35/111, 31.5%) (P=0.01). Although the Lacidofil® cap does not reduce the rate of occurrence of AAD in adult patients with respiratory tract infection who have taken antibiotics, the Lactobacillus group maintains their bowel habits to a greater extent than the placebo group.
Journal of Korean medical science 12/2010; 25(12):1784-91. · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Dans un contexte où la résistance aux antibiotiques est un phénomène de plus en plus préoccupant, une analyse systématique des autres options thérapeutiques semble fondamentale en pathologie infectieuse. Les anticorps polypuis monoclonaux représentent une piste thérapeutique majeure avec le développement d’anticorps dirigés contre les systèmes de virulence spécifiques de certains pathogènes. La modulation du quorum-sensing et des facteurs de virulence en dépendant est une approche en plein développement en pathologie aiguë comme dans les infections chroniques. Enfin, les bactériophages ou les probiotiques peuvent aussi constituer une solution de recours dans divers tableaux infectieux. Cette revue précise les avancées dans chacun de ces domaines de la thérapeutique anti-infectieuse non antibiotique.
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