Prescription for probiotic

Health professionals in the U.S. have been slow to embrace probiotics. European doctors have been recommending probiotics with antibiotics for a long time. For reasons that puzzle us, American physicians and nurses have been wary. That may be because medical and nursing schools have been slow to teach about probiotics. Perhaps that will all change thanks to a new Clinical Evidence Synopsis in JAMA, July 19, 2018.

Clostridium difficile (C. diff) is NASTY!

Clostridium difficile (pronounced Klos-TRID-e-um diff-a-SEAL), aka C. diff or CDI for short, causes horrific diarrhea. In some cases the bacterial infection can become life-threatening. Symptoms include abdominal pain, cramping and watery diarrhea that can be incredibly disruptive. Some people develop bloody diarrhea, fever, dehydration, weight loss and kidney damage. It can be transmitted from one person to another.

Antibiotics can disrupt the ecology of the digestive tract. In other words, the good guys are killed off and the bad guys may multiply. As a result, C. diff bacteria can flourish. Overcoming such an infection can be a daunting process.

It is estimated that as many as 500,000 people develop CDI in any given year. Treating just one patient can cost over $24,000. Even with treatment, some people die.

Will Taking Probiotics with Antibiotics Reduce C. diff Infections?

An article in JAMA suggests the answer is yes. The authors summarized a review from the Cochrane Database of Systematic Reviews, Dec. 19, 2017.  This represents an independent and highly regarded assessment of the available evidence.

The review analyzed 39 clinical trials involving nearly 10,000 patients. The authors wanted to know whether taking probiotics with antibiotics would reduce the risk for patients developing C. diff infection (CDI).

And the Envelope Please:

The authors report:

Co-administration of probiotics and antibiotics was associated with a lower risk for CDI vs placebo or no treatment respectively…”

and

“Probiotics plus antibiotics were associated with a lower risk of adverse events such as abdominal cramping and nausea vs placebo or no treatment…

and

“No trials reported serious adverse events attributable to probiotics. Probiotics plus antibiotics were associated with a lower risk of antibiotic-associated diarrhea vs placebo or no treatment…”

In Summary:

“Among 31 studies comparing antibiotics and probiotics vs placebo or no treatment for preventing CDI in patients receiving antibiotics, probiotics were associated with a lower risk of CDI, adverse events, and antibiotic-associated diarrhea.”

People’s Pharmacy Perspective:

In our opinion, this “Clinical Evidence Synopsis” in JAMA should convince most clinicians to consider recommending probiotics with antibiotics. The trouble is that the FDA seems semi-oblivious to oversight of probiotics. In other words, the agency does not appear to monitor probiotic production or verify that products contain what they claim on the label.

About the only organization that we know that tests such products is ConsumerLab.com. You will have to subscribe to their reports to get the full analysis on probiotics. Here is a link.

Stories from Patients:

Lest you think this is about a tempest in a tea pot, here are some stories from visitors to our website:

Todd in Boston shares this experience:

“I am 52 and in excellent shape. My dentist prescribed clindamycin (4 times a day for a minor infection and upcoming root canal). By the 6th capsule (day and a half dosage), the diarrhea started.

“It was then that I saw the warning label on the insert (not on the bottle): “This medication may cause a severe (rarely fatal) intestinal condition (Clostridium difficile-associated diarrhea) due to a type of resistant bacteria.” My dentist didn’t warn me about it; my pharmacist didn’t warn me about it either.

“In fact, I called my pharmacist immediately and she told me to ‘continue taking it and call your doctor on Monday.’ I didn’t listen to her – I stopped taking it immediately (which is exactly what the CDC recommends). I called my GP Monday, was told to start probiotics immediately. I was given a stool sample kit. Stools were given to the lab the following day.

“I still have diarrhea 4 days after discontinuation. I am waiting for test results to come back from the lab. From everything I’ve read so far, it sounds like it will come back positive.

“I will be calling my gastroenterologist to discuss various treatment options.”

Ellen in Nebraska has been through the wringer:

“I was given clindamycin thru IV because of hip replacement. Five days later I woke up in the middle of the night with severe diarrhea, and I hurt really badly all over. On the second day of diarrhea I went to the doctor. He said it was just an intestinal bug. On the third day I was disoriented but I remember saying I just wanted to die.

“My husband came home from work that night, took one look at me and said, “We are going to the hospital.” I was diagnosed with C. diff. It was affecting my heart. Breathing was difficult. I was very dehydrated. My potassium level was very low. I was very disoriented, and I remember very little of those days.

I was finally able to go home after 3-4 days, very weak, still had diarrhea. Six months later I saw a new doctor who was shocked that I still had diarrhea. I tested positive for C. diff and just finished a round of vancomycin. Now my stools are mushy. I’m hoping that they will return to normal.”

Nancy in Madison, Wisconsin, was sick for a long time:

“I was given clindamycin for a dog bite in July 2015. The bite healed fine. Three weeks later I had what I initially thought was a bad stomach bug. It turned into 5 months of the worst time of my life fighting C. diff.

“Once you get over one round of diarrhea you have increased chances for rebounds of this awful illness. Now after almost two years I am finally beginning to think I am over it. Be very wary of any antibiotics you take in the future.”

You can read more horrifying stories about CDI at this link:

Clindamycin Can Cause Disastrous Diarrhea

Final Word About Probiotics with Antibiotics:

There is no guarantee that taking probiotics with antibiotics will prevent C. diff infection. But the data suggest it can reduce the risk. We are astonished that more health professionals are unaware of the evidence for this approach. Next time you get a prescription for an antibiotic, ask the prescriber whether probiotics might make sense.

Share your own story in the comment section below.

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  1. alan
    Dallas, TX
    Reply

    no dr. has ever said anything about probiotics, but they’ve never said anything negative, either.
    i started probiotics when i became a Shaklee distributor, and have never had any serious issues with diarrhea, either.

  2. Sara
    Southwest Florida
    Reply

    I had a doctor tell me that after a course of antibiotics you should take probiotics for at least 4 months in order to recolonize the bacteria and micro flora in your digestive system. Kimchi is another food that contains probiotics. Also, when probiotics are taken with food they can survive the digestion process better because it protects them from stomach acid. Then they can make it to the intestines alive, and begin to colonize all along the digestive tract.

  3. Victoria
    Ridgeway, VA
    Reply

    I am interested in probiotics and several years ago began making kefir at home. It seems to have much helped an older friend with bowel issues and who didn’t seem much helped by all the meds he had been taking. I know the stuff in the kefir is “live” and wonder about all the boxes of “store bought” and if they contain live stuff or not. Have you considered doing a show on kefir?

  4. Jim
    Boston
    Reply

    There is also a yeast, Saccharomyces Boulardii that has been shown to be helpful I reducing recurring C. Diff. for some ( see link ). Since it is a yeast and not a bacterium, I’m not sure it is considered a probiotic.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805518/

    I contracted C. Diff during a stay in one of the premier Boston cancer centers and was prescribed 7 days of Flaggyl antibiotic to knock it out. No mention of probiotics. Later after doing some of my own research on probiotics, I added a multi-type mixed probiotic and the S. Boulardi yeast. Several days later my diarrhea passed and things began to return to normal.

    Curious if anyone has used the S. Boulardi yeast supplement in addition to standard probiotics and what your experience was.

    • Chaela
      Denver
      Reply

      Used S. Boullardi while on antibiotics for root canal having researched in depth on line. Having had hip replacement in past year, surgeon warned me of need to avoid c. Diff, which could create invasive infection and risk to joint. Seems to have worked. No diarrhea.

  5. Sue
    Newport, OR
    Reply

    My mother knew 60 years ago to always take acidophilis when taking antibiotics. If you took an antibiotic pill once every four hours you were to take a probiotic capsul the two hours in between.

    • Elly
      California
      Reply

      I used sacromycies boulardi after a bout with c diff, have taken antibiotics since, and take probiotic 2 hours before or after antibiotic. So far, so good.

  6. Mary S
    Everett WA
    Reply

    I’ve had C. diff. twice. The first time I had no idea that such a terrible thing could be “caused by” taking an antibiotic. I was so week by the time I called the doctor that I couldn’t go get the test he wanted me to take of my stool. It took a long time to get over it. I didn’t know to take probiotics at that time.

    I caught early the second time went to the hospital and was over it quickly but I was so weakened by it that I fell and broke my hip even though I was taking probiotics at the time.

    I am now taking an antibiotic and probiotics and praying that I don’t get C. diff.

    No warning from doctor, nurses or pharmacy to take probiotics.

  7. Peggy
    Reply

    I would highly recommend saccharomyces boulardii (brand name Florastar) as the very best probiotic to take AT THE SAME TIME as an antibiotic. Since saccharomyces boulardii is actually a “good” yeast, it LOVES antibiotics. It helps rebuild the gut wall very well, too. Approved down to 1 1/2 yrs old (the regular capsules can be opened), and are heat stable. Ok to order on the internet from a reliable company on a hot day. IF you want to optimize the timing of any other regular probiotic (such as Culturelle, which has been studied down to newborns), then take it about 2 hrs AFTER an antibiotic if possible. I would also suggest keep taking probiotics daily for at least 2-4 wks after completing any course of antibiotics. Consider taking probiotics at least once per week in general (and eat lots of veggies and fermented foods, cut down sugars and processed foods). If you have ever had C diff, be aware this bacteria especially loves sugar! So, if you are eating yogurt for the health benefits, stay with the PLAIN Greek or whole fat yogurt. I would also suggest taking vitamin D3, since this can help your immune system as well as reduce leaky gut. Best of health to everyone!

  8. Merle
    Holt, MI (48842)
    Reply

    I developed stomach pain from amoxicillin and my Dr. put me on an oral probiotic that came in small packets that had probiotics in crystal form that I sprinkled on my food this way it starts at the beginning of the digestive tract. It took a few days but did solve the problem. I have a very sensitive stomach that has been a problem all of my life. I eat yogurt and take probiotics. I order my probiotics from Metagenics but there are many good ones, be sure they are refrigerated.

  9. Chuck
    PA
    Reply

    My sister almost died from CDI. One form of probiotics is yogurt, if I’m not mistaken. I have eaten a serving of yogurt every day while on an antibiotic. But maybe it was a coincidence that I did not develop any diarrhea problems. Is yogurt considered a “probiotic”? Thanks for all you do at The People’s Pharmacy!

  10. Gene
    Palm Bay, FL
    Reply

    I took Cipro for an ear infection. Within two days, I had a horrible rash in my groin. I though it was Jock Itch. I then went to the walk in clinic as I could not get in to see my Primary Care Physician (PCP). Thank goodness I couldn’t.

    The Practicing nurse at the walk in clinic told me it was a yeast infection and almost always caused by antibiotics especially Cepro. I think it is called Ceproflaxin. She gave me Diflucan and it cleared right up. She said one should always take a strong probiotic while taking an antibiotic and gave me the name of several good ones, which I have forgotten.

    My PCP never mentioned the side affects of antibiotics. I’ll know better next time not to take a prescription at face value and will do my own research on it before I take it.

    Regards

  11. suzanne
    78006
    Reply

    Yes, PLEASE share which probiotic/brand is best. I have ask my pharmacist and he does not know. I did read a capsule is best. And, is it best to take it every day & does yogurt have enough?

    • Rebekah
      NC
      Reply

      Change to another pharmacy! Any reputable pharmacist should be able to answer your question and even have the probiotic for sale.

  12. Vee
    San Antonio, Texas
    Reply

    My mom was given quinolones over 15 days for UTI while first hospitalized for hip fracture. Then she was transferred to different hospital for inpatient therapy and again was given more quinolones. She went home and seemed to recover fine. Two weeks later she had sudden, uncontrollable diarrhea so bad, it was all over the walls, floor, bed everywhere. EMS took her to ICU at yet a third hospital where she suffered unimaginable pain and trauma from the diarrhea. More antibiotics for C-dif to try and stop it.

    After suffering for almost 3 weeks in ICU, she finally was free of pain. She died. Doctors at first 2 hospitals refused to allow me to bring her probiotics and yogurt. Third hospital’s head dietitian told me if the others had allowed me to give them to her, she never would have gotten
    C-dif. She suffered needlessly. I have been on probiotics and yogurt every single day since Mom died March 6, 2003.

  13. Cherl
    Highland Village, TX
    Reply

    A little bit of specifics, as to when to take the probiotics, when also taking antibiotics.

    I would assume at least an hour between each type of medicine, but I’m sure more time would be desirable. Could you all provide some guidance?

  14. Joyce
    Texas
    Reply

    I always take buttermilk or yogurt with antibiotics and have never had problems.

  15. Gary
    Louisiana
    Reply

    Any possibility that taking probiotics with antibiotics will cancel the effects of both?

  16. Carolyn
    Southport, North Carolina
    Reply

    My son and daughter were born in the seventies. Their pediatrician prescribed probiotics all those years ago when he gave either of them an antibiotic. They never developed diarrhea. Why oh why has it taken almost 50 years for the rest of the medical profession in the US to follow this procedure.

  17. sue
    WI
    Reply

    Was told to take a probiotic with my antibiotic for sinus/bronchitis that did not go away. I became so constipated and dry. My eyes were dry, my mouth. At this time I developed huge floaters in both eyes and am being treated with laser which they can only break up a sm am’t out at once. Medicare requires 3mo between each laser trt. Will need 3-4 trts . These huge floaters really block accurate vision at times. Was told it could be from being dry.

    I was constipated for months. I stopped taking them finally and the tried to restart slower and same thing occurred. Gut not back to normal yet. I normally wait til all else is used before doing antibiotics. AND no quinolones for me either.

  18. Fran
    NC
    Reply

    I live in a retirement community. Once we had a speaker from our local hospital who made a specialty of teaching us about the necessity of probiotics. She even gave us the particular probiotics that were most important. I searched all over the web as to which ones were most important. I alternate between taking them. I assume I cannot name the probiotics here. I am diligent in taking one every day.

    Long ago, the nurse at my closeby emergency facility noticed how often they had given my antibiotics for what was, or I thought was, a urinary infection. She said although the urine shows an infection, “Don’t come back here.” I don’t want to ever give you another antibiotic. That is not the way to go.

    I haven’t been back, but I have learned that when an 88 year old female’s urine shows positive for urinary infection, it is not always true. If I have no pain when I urinate, I assume it isn’t an infection. I do go heavy on my probiotics.

  19. Gael
    Virginia
    Reply

    Please tell us how to find probiotics. What brand/type do you recommend? Does yogurt with active cultures help/

  20. Anna
    Texas
    Reply

    My mom almost died from C-diff. A gastroenterologist from Houston was called in,he prescribed Align probiotics and acidophilus, both over the counter drugs. These saved her life.
    I now take them everyday.

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