Running head: DIARRHEA AND PROBIOTIC USE
Evidence-Based Practice Critically Appraised Topic
Diarrhea & Probiotic Use
Stacy A. Cederstrom BSN, RN, FNP-s
University of Mary
March 7, 2014
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Running head: DIARRHEA AND PROBIOTIC USE
Evidenced Based Practice Critically Appraised Topic: Diarrhea & Probiotic Use
Clinical Scenario
A 76 year old, Caucasian male presents with recurrent episodes of diarrhea for the past 6
months. Patient has history of two episodes of prescribed antibiotic use for pneumonia in past 6
months. Stool: positive for Clostridium difficile infection. Results indicate Clostridium difficile
associated diarrhea.
Clinical Question
In patients with recurrent diarrhea related to infection or Clostridium difficile, do probiotics,
compared to no treatment, reduce incidence of diarrhea related infection?
Articles
Allen, S. J., Martinez, E. G., Gregorio, G. V., & Dans L. F. (2010). Probiotics for treating acute
infectious diarrhoea. Cochrane Database of Systematic Reviews, Issue 12.
doi: 10.1002/14651858.CD003048.pub3
Goldenberg, J. Z., Ma, S. S., Saxton, J. D., Martzen, M. R., Vandvik, P. O., Thorlund, K., …
Johnston, B. C. (2013). Probiotics for the prevention of Clostridium difficile-associated
diarrhea in adults and children. Cochrane Database of Systematic Reviews, (5).
doi: 10.1002/14651858.CD006095.pub3
Summary and Appraisal of Key Evidence
Study 1:
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Running head: DIARRHEA AND PROBIOTIC USE
Allen, Martinez, Gregorio, & Dans, (2010) state that probiotics may offer a safe
intervention in acute infectious diarrhea to reduce the duration and severity of the illness. A trial
was registered in 2010 by the Cochrane Infectious Diseases group. Randomized and quasirandomized controlled trials comparing specified probiotic agents with placebo or no probiotic in
people with acute diarrhea that is proven or presumed to be caused by infectious agents. Primary
outcomes reviewed were the mean duration of diarrhea, stool frequency on day two after
intervention and ongoing diarrhea on day four. Sixty-three studies met required criteria. There
were a total of 8014 participants. The trials found an average of significant mean duration of
diarrhea 24.76 hours with 95% confidence interval 15.9 to 33.6 hours. It was found that diarrhea
lasting greater than or equal to four days and stool frequency on day two had a mean difference
of 0.80;0.45 to 1.14;n=2751. Level of evidence is level 1, study is valid and reliable.
Study 2:
Goldenberg et al. (2013)…. state; disturbances can occur in the gastrointestinal flora of
the patient who is prescribed antibiotics. Reduction in resistance then follows by organisms such
as Clostridium difficile (C. difficile). Probiotics are live organisms thought to balance out the
gastrointestinal flora. In order to assess the efficacy and safety of probiotics for preventing of C.
difficile infections, a Cochrane Review was conducted. Randomized controlled trials
investigating probiotics for prevention of C. difficile were selected. Meta-analysis of 23 random
controlled trials including 4213 participants, moderate quality evidence found that use of
probiotics reduced risk of C. difficile infection by 64%. Level of evidence is level 1, study is
valid and reliable.
Results
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Running head: DIARRHEA AND PROBIOTIC USE
Allen, Martinez, Gregorio, & Dans (2010) state in their Cochrane collaboration;
alongside rehydration therapy, probiotics appear to be safe and have beneficial effects in
shortening the duration of acute infectious diarrhea as well as frequency of stools. They also
found that vomiting occurred less frequently with the use of probiotics than the control groups.
Goldenberg et al. (2013)… state there is overall evidence suggesting use of probiotics
reduce the incidence of C. difficile infection when taking during antibiotic use. They also state
there is a protective affect that occurs within the intestine during use of probiotics. Probiotics
also appear to be safe in immunocompromised patients.
Areas of Conflict
The Cochrane reviews did not distinguish the particular probiotics used in the studies.
Detailed and defined treatment dosages and regimens were also not identified. More research
needs to be done to determine a guide for particular probiotic regimens or specific types of
probiotics for infectious diarrhea. More research must also be conducted on optimal dosage,
starting point and end of treatment while taking antibiotics. Specific organisms need to be
identified for benefits of use with infectious diarrhea to minimize symptomology with probiotics.
Clinical Bottom Line:
Probiotics have been found to be affective in decreasing the duration of infectious
diarrhea as well as decreasing vomiting associated with diarrhea. Probiotics have been found
safe to use in patients who are taking a course of antibiotics as well in immunocompromised
patients.
Implications for nursing practice:
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Running head: DIARRHEA AND PROBIOTIC USE
With implementation of probiotic use for infectious related diarrhea, patients will have a
decreased length of illness as well as improvement of associated symptoms like vomiting.
Administering probiotics is an effective way to maintain gut flora during the use of antibiotics.
The course of illness can be shortened as well as severity of impact for patients.
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Running head: DIARRHEA AND PROBIOTIC USE
References
Allen, S. J., Martinez, E. G., Gregorio, G. V., & Dans L. F. (2010). Probiotics for treating acute
infectious diarrhoea. Cochrane Database of Systematic Reviews, Issue 12.
doi: 10.1002/14651858.CD003048.pub3
Goldenberg, J. Z., Ma, S. S., Saxton, J. D., Martzen, M. R., Vandvik, P. O., Thorlund, K., …
Johnston, B. C. (2013). Probiotics for the prevention of Clostridium difficile-associated
diarrhea in adults and children. Cochrane Database of Systematic Reviews, (5).
doi: 10.1002/14651858.CD006095.pub3
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