Evidence Based Appraisal of the Use of Probiotics to Prevent Antibiotic-associated Diarrhea in Intensive Care Settings

It is estimated that between 5-25% of adults who receive antibiotic therapy develop antibiotic-associated diarrhea (AAD) (Cimperman et al., 2011; McFarland, 2009). When untreated, AAD can lead to dehydration, electrolyte imbalances, and skink breakdown, which may cause hospitalization. This paper provides a review of the literature related to the prophylactic use of probiotics to reduce the incidence of antibiotic-associated diarrhea. In addition, based on the findings, a set of recommendations are presented for the use of prophylactic probiotics to control ADD in intensive care populations. Sources were obtained from CINAHL plus with full text, MEDLINE (CSA), Health Reference Center Academic, MEDLINE (OVID), and Cochrane Reviews. Based on the available evidence, there is consensus that antibiotic-associated diarrhea is significantly decreased when higher doses of probiotics (10^10 CFU, BID) are given within 36 hours of antibiotic administration. In addition, the probiotics should be continued for 4-6 weeks, using preparations of Lactobacillus or the strain Saccahromyces boulardi.