Bacteria-killing antibiotics have proved to be a friend to mankind, saving countless millions of people worldwide. However, not all bacteria are pathogenic and antibiotics do not differentiate between beneficial and pathogenic bacteria.
Medication-associated diarrhea (antibiotic and chemotherapy) has become increasingly common, especially in hospitals and nursing homes. One of the most common bacteria associated with medication-associated diarrhea is Clostridium difficile (C. difficile). However, nature may have provided an important element in the prevention of C. difficile-mediated diarrhea -- good bacteria or probiotics.
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The combination of exposure to C. difficile plus a course of antibiotics can trigger C. difficile-mediated diarrhea. Medical research suggests that good bacteria inhibits C. difficile growth. However, a single seven-day course of antibiotics may kill much of the good bacteria, allowing C. difficile to grow unchecked.
C. difficile can release powerful toxins that damage the intestines resulting in abdominal pain and diarrhea. In the most severe cases, life-threatening illnesses can result. Paradoxically, the antibiotics used to treat this infection can also cause this infection.
After antibiotic therapy, relapses of C. difficile diarrhea can approach 20 percent.
There is also a significant increase in the rate of C. difficile associated with the use of medications that inhibit stomach acid production. Such medications are commonly used in hospitalized patients.
Using good bacteria (probiotics) may inhibit the growth of the pathogenic and reduce the risk of developing C. difficile diarrhea. A number of medical studies over the past decade have suggested that probiotics can prevent or at least significantly reduce the risk of C. difficile infection in patients taking antibiotics.
One study (done in England in 2008), double-blinded and placebo-controlled, had 135 hospitalized patients consume either a placebo or a specific probiotic-rich yogurt drink during and after antibiotics. No patient consuming the yogurt drink developed C. difficile diarrhea. In contrast, 17 percent of the patients consuming the placebo developed C. difficile diarrhea.
Another study in Sweden in 2008 involved 22 seriously ill patients in the intensive care unit and treated with antibiotics. Half of the patients were given a probiotic and half were given a placebo. Nineteen percent of the patients taking the placebo became infected with C. difficile. In those patients taking the probiotic, none were affected with C. difficile.
C. difficile is the primary reason for infectious diarrhea in hospitalized patients. Medical costs associated with C. difficile infection are substantial and include extended hospitalization, re-hospitalization, multiple laboratory tests and expensive medications (including more antibiotics).
For an initial infection, medical costs range between $2,871 to $4,846 per patient and $13,655 to $18,067 per patient for a recurrent C. difficile infection.
Daily probiotics, for an average length of hospitalization with antibiotic therapy, is probably less than $5. Improving medical outcomes and reducing medical costs is not the sole domain of technology and medications. Let nature do some of the work and at a fraction of the cost.
• Patrick B. Massey, M.D., Ph.D is medical director for complementary and alternative medicine for the Alexian Brothers Health System. His website is www.alt-med.org.