Randomized Controlled Trial
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World J Gastroenterol. Nov 14, 2014; 20(42): 15837-15844
Published online Nov 14, 2014. doi: 10.3748/wjg.v20.i42.15837
Commercially available probiotic drinks containing Lactobacillus casei DN-114001 reduce antibiotic-associated diarrhea
Christoph G Dietrich, Tanja Kottmann, Manuela Alavi
Christoph G Dietrich, Manuela Alavi, Department of Medicine, Bethlehem Hospital, Teaching Hospital of Aachen University RWTH, 52222 Stolberg, Rhineland, Germany
Tanja Kottmann, Private Institute of Medical Statistics, 52222 Hamm, Westfalen, Germany
Author contributions: Dietrich CG supervised the data acquisition and prepared the manuscript. Kottmann T conducted all of the statistical analyses; Alavi M designed the study and obtained the majority of the data; all of the authors approved the final version of the manuscript.
Correspondence to: Christoph G Dietrich, MD, PhD, Department of Medicine, Teaching Hospital of Aachen University RWTH, Bethlehem-Gesundheitszentrum, Steinfeldstraße 5, 52222 Stolberg, Rheinland, Germany. dietrich@bethlehem.de
Telephone: +49-2402-1074223 Fax: +49-2402-1074431
Received: March 11, 2014
Revised: May 26, 2014
Accepted: June 26, 2014
Published online: November 14, 2014
Processing time: 251 Days and 13.6 Hours
Abstract

AIM: To investigate the effect of Lactobacillus-containing commercially available probiotic formulations in Germany during antibiotic treatment with an analysis of cost-efficiency.

METHODS: In an observational study, we analyzed the frequency of bowel movements from 258 patients with infections in a primary care hospital in western Germany; 107 of the patients were offered a probiotic drink containing at least 10 billion cultures of Lactobacillus casei DN 114001 b.i.d. The economic analysis was based on the costs of patient isolation vs preventive intake of probiotics. In a second pilot study, two commercially available probiotic drinks with different Lactobacillus casei strains were directly compared in 60 patients in a randomized controlled fashion.

RESULTS: In the first study, the incidence of antibiotic-associated diarrhea (AAD) was significantly reduced in the intervention group (6.5% vs 28.4%), and the duration of AAD in days was significantly shorter (1.7 ± 1.1 vs 3.1 ± 2.1). Higher age and creatinine and lower albumin were identified as risk factors for AAD. Ampicillin was the antibiotic with the highest rate of AAD (50%) and with the greatest AAD reduction in the probiotic group (4.2%, relative risk reduction 92%). The economic analysis showed a cost advantage of nearly 60000 €/year in a department of this size. The second study confirmed the preventive effect of the drink with Lactobacillus casei DN114001; however, there were no advantages found for the other tested probiotic drink containing Lactobacillus casei Shirota.

CONCLUSION: In contrast to a drink containing Lactobacillus casei Shirota, a commercially available probiotic drink containing Lactobacillus casei DN 114001 cost-efficiently reduces the prevalence of AAD during antibiotic treatment.

Keywords: Antibiotics-associated diarrhea; Probiotics; Lactobacillus casei

Core tip: The presented study used a large primary hospital cohort to test the effect of a commercially available probiotic drink in the prevention of antibiotic-associated diarrhea (AAD) in a decision-based manner. This is the first manufacturer-independent study showing a clear advantage of a probiotic drink containing Lactobacillus casei DN 114001 in AAD prevention. The study additionally contains a calculation of cost-effectiveness and identifies risk factors for AAD. In a second small pilot study, we compared for the first time two commercially available drinks in a head-to-head analysis.