Probiotic Use in Diarrhea Prevention and Treatment

Introduction to Probiotic Benefits and Risks

• The American Gastroenterological Association states there is insufficient evidence to recommend specific probiotics for IBS, and if attempted, treatment duration should not exceed 12 weeks 1, 2
• Lactobacillus rhamnosus GG or Saccharomyces boulardii reduce the risk of antibiotic-associated diarrhea by approximately 50% 1, 3
• Probiotics reduce Clostridioides difficile infection risk by 64% when given with antibiotics 1, 3

Therapeutic Uses of Probiotics

• Therapeutic doses are typically ≥10^10 CFU/day for 5 days in acute diarrhea 1
• The American Gastroenterological Association recommends against probiotic use in children with acute infectious gastroenteritis in the US/Canada, based on two large trials showing no benefit 1, 3

Special Populations

• For patients with ulcerative colitis, probiotics may be a practical option for both induction and maintenance therapy 4
• For patients with Crohn's disease, probiotics are not effective and should not be routinely used 4

Safety Considerations

• Avoid probiotics entirely in immunocompromised patients, premature neonates, patients with central venous catheters, critically ill patients, cardiac valvular disease, and short-gut syndrome 1, 2, 3, 4

Practical Guidelines for Probiotic Use

• If antibiotic-associated diarrhea prevention, use L. rhamnosus GG or S. boulardii 1, 3
• If acute gastroenteritis in North America, do not use probiotics 1, 3
• If IBS, insufficient evidence; if attempted, limit to 12 weeks 1, 2