"I have to say, if someone comes in with uncomplicated community-acquired pneumonia, I oftentimes don’t prescribe prophylactic probiotics unless they’ve had C. difficile–associated diarrhea before or they’re very fragile. But if something is even a little bit wrong with you, bad diarrheal illness can be the straw that breaks the camel’s back. And I strongly think about prophylactic probiotics in folks on long-term antibiotics, like for a diabetic foot ulcer," he noted.
Dr. Anderson said his typical prescription is for two Lactobacillus acidophilus capsules twice daily.
"The randomized studies done to date don’t let us know the optimal mix of critters or how much is enough," according to the hospitalist.
While preventive probiotic therapy is low cost, Dr. Dominguez noted that a more high-tech therapy for secondary prevention of C. difficile infection is in the developmental pipeline.
A pair of neutralizing, fully human monoclonal antibodies against C. difficile toxins A and B administered together in a single infusion in a randomized, double-blind, placebo-controlled, phase II clinical trial in patients with C. difficile–associated diarrhea didn’t have any effect on duration of hospitalization for that episode. However, it did result in a highly significant 72% reduction in recurrence, according to investigators at Medarex in Princeton, N.J., and the University of Massachusetts, Boston (N. Engl. J. Med. 2010;362:197-205).
"This may be a useful tool in the future for preventing recurrences," Dr. Dominguez commented.
Dr. Dominguez and Dr. Anderson reported having no financial conflicts of interest.