Probiotics May Prevent Deadly Diarrhea
WASHINGTON — In hospitalized patients taking antibiotics, coadministration of the probiotic Saccharomyces boulardii can reduce costs and shorten hospital stay by about 3 days, and may even save lives, Allyson L. Rovetto and her associates reported in a poster at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.
Antibiotic-associated diarrhea (AAD) occurs in up to 30% of all hospitalized patients given antibiotics. Clostridium difficile-associated diarrhea (CDAD) is both the most common and the most severe manifestation of the problem, with potential complications including colitis, ileitis, toxic megacolon, and death. A recent conservative estimate of the cost of CDAD—not including physicians' costs or posthospital care costs—was $1.1 billion per year in the United States, noted Ms. Rovetto and her associates, of Mount Sinai School of Medicine, New York.
Growing evidence suggests that probiotics such as the live, nonpathogenic yeast S. boulardii may be effective in preventing AAD and recurrent CDAD, although that organism is linked to increased risk for fungemia, which may also lead to severe complications and death (Clin. Infect. Dis. 2005;40:1625–34).
In a study funded in part by the National Center for Complementary and Alternative Medicine of the National Institutes of Health, the investigators used data from published literature to perform a cost-effectiveness analysis of administering vs. not administering S. boulardii along with antibiotics to hospitalized patients.
The probability of CDAD was estimated to be 2% among those given the probiotic along with antibiotics vs. 5% given antibiotics alone. The increase in hospital cost per patient with CDAD was $4,129, and the probability of CDAD complications was 3%. The cost of S. boulardii treatment is approximately $20. No firm estimates of the rate of fungemia due to S. boulardii are available, although it appears to be increasing.
Compared with antibiotics alone, treatment with antibiotics plus the probiotic yielded a cost saving of $81.60 per patient in addition to shortening hospital stays by about 3 days.
Patients older than 65 and those with hospital stays longer than 2 weeks stand to benefit the most. The analysis revealed that even if the protective effect of S. boulardii were halved, it would remain the preferred strategy. In fact, the only way the probiotic's benefit would be offset is if the incidence of fungemia exceeded 2 per 100 patients, “which seems highly unlikely,” they remarked.
The meeting was sponsored by the American Society for Microbiology.
