Probiotics for Antibiotic Prophylaxis

Recommended Probiotic Strains

The American Gastroenterological Association conditionally recommends a two-strain combination of L. acidophilus CL1285 and L. casei LBC80R for prophylaxis during antibiotic therapy 2, 5
Saccharomyces boulardii I-745 at a dose of 1 g/day is recommended as a first-line probiotic for antibiotic prophylaxis based on multiple clinical trials showing efficacy 3, 2
A three-strain Lactobacilli combination (L. acidophilus CL1285, L. casei LBC80R, and L. rhamnosus CLR2) has demonstrated significant reduction in C. difficile infection rates 1, 4
Other effective options include L. casei Shirota and Lactobacillus plantarum 299v, which have shown efficacy in hospital studies 1, 4
A four-strain combination of L. acidophilus, L. delbrueckii subsp bulgaricus, B. bifidum, and Streptococcus salivarius subsp thermophilus is also recommended 2, 5

Probiotics are most beneficial for elderly patients at high risk of C. difficile infection 2, 5
Hospitalized patients receiving antibiotics can benefit from probiotics to reduce the risk of C. difficile infection 1, 4
Patients with previous episodes of antibiotic-associated diarrhea can benefit from probiotics 2, 5
During C. difficile outbreaks in healthcare facilities, probiotics can be used to reduce the risk of infection 1, 4
For patients with a history of recurrent C. difficile infection, S. boulardii combined with high-dose vancomycin (2 g/day) has shown significant reduction in recurrence rates (17% vs 50%) 1, 6

Probiotics are contraindicated in immunocompromised patients due to risk of bacteremia or fungemia 1, 7

The overall quality of evidence supporting probiotic use for antibiotic prophylaxis is moderate 2, 5
The number needed to treat to prevent one case of antibiotic-associated diarrhea is approximately 9 patients overall, and 6 patients when using high-dose probiotics 2