Research
Hospital inpatients increasingly receiving probiotics: Survey
Image: iStockPhoto / _lolik_
By Stephen Daniells 15-Mar-2016

A "sizable and growing number" of inpatients are receiving probiotics, according to a survey of 145 US hospitals.

Data published in the American Journal of Infection Control indicated that probiotics were used in 2.6% of hospitalizations and 96% of the hospitals surveyed (2012 data).

The most common probiotics used were Saccharomyces boulardii, Lactobacillus acidophilus, L. bulgaricus, L. acidophilus, and L. rhamnosus.

"Manipulation or remediation of the microbiome may be an important strategy for prevention of health care-associated infections in the future," wrote Sarah Yi, PhD, John Jernigan, MD, and Clifford McDonald, MD from the Centers for Disease Control and
Prevention.

"Whether probiotics are effective in preserving or restoring a healthy microbiome remains unknown, but the high prevalence of probiotic use among hospitalized patients may indicate a growing belief among clinicians that these agents may be an effective
strategy for doing so. Currently, there is not enough evidence to support use of currently available probiotics in this clinical setting."

NY Times & the IPA

The paper was picked up by the New York Times reporter Nicholas Bakalar, who quoted Dr Yi: "It's understandable that people want to use probiotics, but the benefits are uncertain. There's no research that definitively shows they are effective, certainly
not enough to create guidelines for their use."

In response to these statements, the International Probiotics Association has that, contrary to Bakalar's report, there is substantial documentation on the efficacy of probiotics in clinical settings.

"While Mr. Bakalar is correct that a study from a few years ago failed to see a benefit of probiotics over placebo in an antibiotic associated diarrhea study [1]; this study does however suffer from some limitations, such as low compliance. Despite this
study, the overall outcome of probiotics on Clostridium difficile associated diarrhea remains positive as was shown in a recent meta-analysis [2]. The paper by Yi and co-workers is in this perspective also interesting as it thoroughly investigates the
use of probiotics in hospital settings, but draws conclusions on their efficacy and safety, which were not the focus of the study.

The IPA statement continued: "When using probiotics in a hospital setting, it is important to make a risk-benefit evaluation as is done for all medical interventions. Of course, more studies are always appreciated and will increase our understanding of
probiotics (or any other medical intervention for that matter). But, there are a few areas where there is very compelling evidence on the benefit of probiotics, the authors could also wonder if it is ethical not to use probiotics, which in the end have
very little side effects (this in contrast to many medications) and substantial benefits.

"The International Probiotics Association (IPA), acting as the probiotic industry ombudsman, is committed to substantiated probiotic products with science at the forefront. IPA welcomes the research being published in the indutry and encourages its
evolution, as this will continue to forge credibility with all stakeholders. As clinical trials are never predictable it is however the only way to continue the expansion of the scientific data which ultimately results in benefits to the consumers."

Source: American Journal of Infection Control
Published online ahead of print, doi: 10.1016/j.ajic.2015.12.001
"Prevalence of probiotic use among inpatients: A descriptive study of 145 U.S. hospitals"
Authors: S.H. Yi, J.A. Jernigan, L.C. McDonald

Research cited by IPA:
[1] The Lancet
2013, Vol. 382, Issue 9900, pp. 1249-1257
"Lactobacilli and bifidobacteria in the prevention of antibiotic-associated diarrhoea and Clostridium difficile diarrhoea in older inpatients (PLACIDE): a randomised, double-blind, placebo-controlled, multicentre trial"
Authors: S.J. Allen, et al.

[2] International Journal of General Medicine
2016. Volume 9, Pages 27-37
"Probiotics are effective at preventing Clostridium difficile-associated diarrhea: a systematic review and meta-analysis"
Authors: C.S. Lau, R.S. Chamberlain



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