Use of Probiotics in Larger Controlled Trials in Humans Prevention of Diarrhea antibiotic associated diarrhea infantile diarrhea traveler’s diarrhea Treatment of Diarrhea Clostridium difficile disease acute diarrhea - pediatric and adult

D’Souza et al., BMJ 2002;324:1361

Saccharomyces boulardii and Antibiotic Associated Diarrhea in Hospitalized Patients N=180; site: University of Washington, Harborview Hospital Start Antibiotic Stop Antibiotic Stop Study Yeast continued for 14d Start Yeast (within 48h)

Surawicz et al., Gastroenterol. 1989;96:981

Huang, et al. , Digestive Diseases and Sciences, Vol. 47, No Huang, et al., Digestive Diseases and Sciences, Vol.47, No. 11 (Nov 2002)

McFarland et al., JAMA; 271, 1913-1918, (1994).

S. boulardii & High Dose Vancomycin for C. difficile Disease [Results] 50% *p=0.05 16.7%* Placebo (n=14) S. boulardii (n=18) Surawicz CM. Clin Infect Dis 2000;31:1012-7.

Other Uses for Probiotics –Limited Data Crohn’s Disease Ulcerative Colitis Pouchitis Allergy/Exema Irritable Bowel Syndrome Dental caries High Cholesterol Urinary Tract Infections Helicobacter pylori Lactose Intolerance Candida vaginal infections Bacterial Vaginosis

From Elmer GW, Am J. Health-Sys Pharmacy 2001;58:1101-1107 Lactobacillus plantum for IBS looks promising

Probiotics Summary Living microorganisms with multiple mechanisms of action Good safety profile Some applications to prevent and treat infectious diseases An alternative to antimicrobials in some situations May have other applications, e.g. allergy, colitis Product selection is important