Antibiotic-Associated Diarrhea Reduced by Lactobacillus: In a very large 740-patient Indian DB PC study of patients on ampicillin and cloxacillin, the rate of antibiotic-associated diarrhea in the placebo group was 13% vs. 0% with Lactobacillus. Antibiotic associated diarrhoea: a controlled study comparing plain antibiotic with those containing protected lactobacilli. Ahuja MC, Khamar B. J Indian Med Assoc. 2002 May;100(5):334-5

Antibiotic-Associated Diarrhea Considerably Reduced by Yogurt in Two Studies: In an Indiana University DB PC study of 202 hospitalized patients (aver. age 70) given oral or IV antibiotics, half were given two cups of live commercially available yogurt and all were followed for eight days during which many were discharged home.  Those given the live yogurt had fewer days of diarrhea (23 vs. 60) with half as many developing diarrhea (12% vs. 24%). A randomized trial of yogurt for prevention of antibiotic-associated diarrhea. Beniwal RS, Arena VC, Thomas L, Narla S, Imperiale TF, Chaudhry RA, Ahmad UA Dig Dis Sci. 2003 Oct;48(10):2077-82; The total number of bacteria in at least 90% of yogurt in a recent Polish study was in the range 10(7)-10(9) c.f.u. in 1g.

    Lactobacillus acidophilus and Lactobacillus bulgaricus were used in a DB PC study of 79 hospitalized patients receiving ampicillin. None of the patients receiving the bacteria developed ampicillin-induced diarrhea, whereas 14% of the placebo group developed diarrhea. Gotz V., Romankiewicz J. A., Moss J., Murray H. W. Prophylaxis against ampicillin-associated diarrhea with a lactobacillus preparation. Am. J. Hosp. Pharm. 1979;36:754-757

Antibiotic-Associated Diarrhea Prevented by Yogurt: In a randomized study of 27 teens and adults with sinus or respiratory infections, all received amoxicillin with augmentin and half consumed lactobacillus yogurt. Effect of Lactobacillus acidophilus on antibiotic-associated gastrointestinal morbidity: a prospective randomized trial. Witsell DL, Garrett CG, Yarbrough WG, Dorrestein SP, Drake AF, Weissler MC. J Otolaryngol. 1995 Aug;24(4):230-3

Antibiotic-Associated Diarrhea Reduced by Probiotic Yeast in Multiple Studies: Using S. boulardii, a patented yeast preparation used in many countries in a DB PC study of 180 hospitalized patients receiving antibiotic therapy, the overall incidence of diarrhea in these patients was 26%; 22% of the patients receiving placebo developed diarrhea compared with 9% of patients receiving S. boulardii. Surawicz C. M., Elmer G. W., Speelman P., McFarland L. V., Chinn J., van Belle G. Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: a prospective study. Gastroenterology 1989;96:981-988; 

    In a DB PC study of 388 ambulatory patients, receiving either tetracycline or a ß-lactam, concurrently with placebo or S. boulardii, the incidence of diarrhea in patients receiving the placebo was 17.5%, whereas in patients receiving S. boulardii, it was 4.5%. Adam J., Barret A., Barret-Bellet C. Essais cliniques controles en double insu de l’ultra-levure lyophilisée: étude multicentrique par 25 médecins de 388 cases. Gaz. Med. Fr. 1977;84:2072-2078. 

    Another DB PC study of 193 patients receiving at least one broad-spectrum ß-lactam antibiotic found that of the 97 patients receiving S. boulardii, only 7.2% developed antibiotic-associated diarrhea compared with 14.6% of the 96 patients receiving placebo. McFarland L. V., Surawicz C. M., Greenberg R. N., Elmer G. W., Moyer K. A., Melcher S. A., Bowen K. E., Cox J. L. Prevention of beta-lactam-associated diarrhea by Saccharomyces boulardii compared with placebo. Am. J. Gastroenterol. 1995;90:439-448

Burn Patient Diarrhea Helped by Bifido Preparation: In a Chinese study of 43 severely burned patients with diarrhea, the proportions of bifidobacteria and bacteroid decreased significantly, whereas those of aerobe and Candida increased relatively. The ratio of anaerobe to aerobe decreased. As a result, the patients' intestinal flora were distorted. After six days treatment of bifidobacteria, diarrhea in most patients ceased and the intestinal microflora restored. A preliminary clinical study of bifidobacteria preparation on the treatment of diarrhea in severely burned patients. Chen J, Zhang Y, Xiao G. Chin Med J (Engl). 1998 Apr;111(4):381-2

Burn Patient Diarrhea Quickly Resolves by Yogurt: In a Chinese report of 43 burn patients with diarrhea, within six days of starting using a bifidobacteria preparation, the diarrhea stopped in most with a normalization of their bacterial flora.  A preliminary clinical study of bifidobacteria preparation on the treatment of diarrhea in severely burned patients. Chen J, Zhang Y, Xiao G. Chin Med J (Engl). 1998 Apr;111(4):381-2

Childhood Diarrhea Helped by Probiotics in Meta-Analysis: A meta-analysis of 18 randomized studies of children with diarrheal illnesses found diarrhea was shortened by an average of 1 day in both in-patient and out-patient studies and that the difference was highly significant. Children's Hospital, Boston. Efficacy of probiotic use in acute diarrhea in children: a meta-analysis. Huang JS, Bousvaros A, Lee JW, Diaz A, Davidson EJ. Dig Dis Sci. 2002 Nov;47(11):2625-34

Childhood Diarrhea in Residential Care Reduced: In a DB PC study of a milk formula supplemented with viable Bifidobacterium lactis strain Bb 12 (BbF) in 90 infants younger than 8 months living in residential nurseries or foster care centers, 28% vs. 39% developed diarrhea with the diarrhea lasting 5 vs. 7 days resulting in a 60% decrease in diarrheal days in the yogurt milk group. (P = 0.0002 and 0.0014). Acidified milk formula supplemented with bifidobacterium lactis: impact on infant diarrhea in residential care settings. Chouraqui JP, Van Egroo LD, Fichot MC. Grenoble, France. J Pediatr Gastroenterol Nutr. 2004 Mar;38(3):288-92

Childhood: Infant Formula Fermented with Yogurt Bacteria did Better: In a DB PC study of 971 infants aged 4-6 months, those given an infant formula (FF) fermented with Bifidobacterium breve C50 and Streptococcus thermophilus 065) had the same growth of the infants and acceptability of formula as the standard formula. The incidence, duration of diarrhea episodes, and number of hospital admissions did not differ significantly between groups. However, episodes were less severe in the FF (fermented formula) group. There were fewer cases of dehydration 2.5% vs. 6.1% (P = 0.01), fewer medical consultations (46% vs. 56.6%, P = 0.003), fewer ORS prescriptions 41.9% vs. 51.9% (P = 0.003) and fewer switches to other formulas (59.5% vs. 74.9%, P = 0.0001) in FF infants compared to standard. Effects of long-term consumption of a fermented infant formula (with Bifidobacterium breve c50 and Streptococcus thermophilus 065) on acute diarrhea in healthy infants. Thibault H, Aubert-Jacquin C, Goulet O. Paris, France. J Pediatr Gastroenterol Nutr. 2004 Aug;39(2):147-52

Childhood Diarrhea: Live Yogurt Reduces: In a DB PC Delhi study of 150 children with acute diarrhea, half hospitalized, those given a live yogurt culture food for 3 months had a 40% decrease in diarrhea compared to children given the same food which had been heat treated to kill the bacteria. Feasibility studies to control acute diarrhoea in children by feeding fermented milk preparations Actimel and Indian Dahi. Agarwal KN, Bhasin SK. Eur J Clin Nutr. 2002 Dec;56 Suppl 4:S56-9; Similar in France. J Pediatr Gastroenterol Nutr. 2001 Sep;33(3):307-13

Childhood Diarrhea: Yogurt Bacteria Help Acute Childhood Diarrhea in Hospital: In a Taiwanese DB PC study of 100 children hospitalized due to rotavirus positive or rotavirus negative diarrhea, all received IV hydration and half were given four capsules a day containing lactobacillus and bifidobacillus. The frequency of diarrheal stools decreased on the first and second days with the probiotic bacteria and the duration of diarrhea was significantly less at 3.1 days vs. 3.6 days. Oral bacterial therapy promotes recovery from acute diarrhea in children. Lee MC, Lin LH, Hung KL, Wu HY. Acta Paediatr Taiwan. 2001 Sep-Oct;42(5):301-5

Childhood Diarrhea: Lactobacilli Reduce In-Hospital Diarrhea and Duration of Stay: In a Danish DB PC study of children with diarrhea, those in the lactobacilli group had diarrhea shortened by 20%. The impact was much more significant on those starting treatment early with a 48% decrease in hospital stay. Effect of probiotic Lactobacillus strains in young children hospitalized with acute diarrhea. Rosenfeldt V, Michaelsen KF, Jakobsen M, Larsen CN, Moller PL, Pedersen P, Tvede M, Weyrehter H, Valerius NH, Paerregaard A. Pediatr Infect Dis J. 2002 May;21(5):411-6

Childhood Diarrhea Decreased Equally Well by Yogurt Lactobacillus or S. boulardii: In an Argentine DB PC study of 89 children with acute diarrhea, 6 ounces of yogurt, a similar amount with S. boulardi beneficial yeast, or placebo were given twice a day. 44% of the children had cultures for pathogenic bacteria and 27% tested positive for rotavirus. Both treatments considerably decreased the number of diarrheal stools, amount of vomiting, and duration of illness. They were equally well effective in rotavirus positive and negative patients. Effect of Lactobacillus strains and Saccharomyces boulardii on persistent diarrhea in children. Gaon D, Garcia H, Winter L, Rodriguez N, Quintas R, Gonzalez SN, Oliver G. Medicina (B Aires). 2003;63(4):293-8

Clostridium Diarrhea Recurrence: Lactobacillus Plantarum Probiotic Reduces: In a small DB PC study of just 21 patients, those given metronidazole plus Lactobacillus had a 36% recurrences vs. 67% for metronidazole plus placebo. Lactobacillus plantarum 299v for the treatment of recurrent Clostridium difficile-associated diarrhoea: a double-blind, placebo-controlled trial. Wullt M, Hagslatt ML, Odenholt I. Scand J Infect Dis. 2003;35(6-7):365-7

Clostidium Diarrhea Prevented by Yogurt Like Probiotic: In a 20-day DB PC study of 150 patients receiving antibiotic therapy, a probiotic containing both Lactobacillus and Bifidobacterium diarrheal samples tested positive for C. difficile-associated toxins was 2.9% in the probiotic group vs. 7.25% for placebos. When samples from all patients were tested (rather than just those developing diarrhoea) 46% of probiotic were toxin-positive vs. 78% for placebo. Clostridium difficile pilot study: effects of probiotic supplementation on the incidence of C. difficile diarrhoea. Plummer S, Weaver MA, Harris JC, Dee P, Hunter J. Int Microbiol. 2004 Mar;7(1):59-62

DayCare Diarrhea Reduced by Live Yogurt: In a DB PC study of 287 French day care children (aver. age 19 months), those given 1/2 to 1 cup of live-culture yogurt per day had less severe diarrhea over a six month period (4.3 vs. 8.0 days). The effect of supplementation with milk fermented by Lactobacillus casei (strain DN-114 001) on acute diarrhoea in children attending day care centres. Pedone CA, Bernabeu AO, Postaire ER, Bouley CF, Reinert P. Int J Clin Pract. 1999 Apr-May;53(3):179-84

DayCare Diarrhea Reduced by Lactobacilli: In a DB PC Danish study of children in day cares given five days of Lactobacilli twice a day on developing diarrhea had the duration of the diarrhea reduced by roughly 30%. Early intervention was more effective. Effect of probiotic Lactobacillus strains on acute diarrhea in a cohort of nonhospitalized children attending day-care centers. Rosenfeldt V, Michaelsen KF, Jakobsen M, Larsen CN, Moller PL, Tvede M, Weyrehter H, Valerius NH, Paerregaard A. Pediatr Infect Dis J. 2002 May;21(5):417-9

Endometriosis Helped by Lactobacillus in Monkeys: Monkeys with endometriosis had a significantly lower Lactobacilli concentrations and higher Gram-negative bacteria concentrations. There was a higher prevalence of intestinal inflammation in monkeys with endometriosis in comparison to healthy controls. In a Endometriosis is associated with an altered profile of intestinal microflora in female rhesus monkeys. Bailey MT, Coe CL. University of Wisconsin. Hum Reprod. 2002 Jul;17(7):1704-8. Ed: While lactobacillus may not protect against the development of endometriosis, the amazing thing is that not a single study listed on PubMed has ever explored this possibility!

HIV Diarrhea Dramatically Reduced by Probiotic Yeast: S. boulardii was used to treat 33 HIV patients with chronic diarrhea. In these double-blind studies, 56% of patients receiving S. boulardii had resolution of diarrhea compared with only 9% of patients receiving placebo. Saint-Marc T., Rossello-Prats L., Touraine J. L. Efficacy of Saccharomyces boulardii in the treatment of diarrhea in AIDS (letter). Ann. Med. Intern. 1991;142:64-65

Infant Growth Better with Yogurt: In a DB PC study of 151 Thai children on formula, those receiving bifidobacterium yogurt in their formula or bifidobacterium plus S. thermophilus had better weight gain over the six month study than the control group. Effect of bifidobacterium Bb12 with or without Streptococcus thermophilus supplemented formula on nutritional status. Nopchinda S, Varavithya W, Phuapradit P, Sangchai R, Suthutvoravut U, Chantraruksa V, Haschke F. J Med Assoc Thai. 2002 Nov;85 Suppl 4:S1225-31

Infant Diarrhea Less with Live Yogurt: In a large DB PC study of 928 French infants fed either 100 g/day live-culture yogurt with L. casei or standard yogurt, 16% infants fed the live-culture had diarrhea during the study period vs. 22% fed sterilized yogurt. Multicentric study of the effect of milk fermented by Lactobacillus casei on the incidence of diarrhoea. Pedone CA, Arnaud CC, Postaire ER, Bouley CF, Reinert P. Int J Clin Pract. 2000 Nov;54(9):568-71. 

N-G Tube Enteral Feeding Diarrhea Reduced: Patients receiving nasogastric tube feeding frequently develop diarrhea. Two separate DB PC studies have demonstrated a significant reduction in diarrhea in these patients when they were given S. boulardii (Bleichner G., Blehaut H., Mentec H., Moyse D. Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients. A multicenter, randomized, double-blind placebo-controlled trial. Intensive Care Med. 1997;23:517-523; Tempe J. D., Steidel A. L., Blehaut H., Hasselmann M., Lutun P., Maurier F. Prevention of diarrhea administering Saccharomyces boulardii during continuous enteral feeding. Sem. Hop. 1983;59:1409-1412).

Puppies Grow Better with L. acidophilus: In a 13-week random assignment study, puppies with L. acidophilus added to their diet grew more. The impact had disappeared by adulthood. India. Effect of lactobacillus supplementation on growth and nutrient utilization in mongrel pups. Pasupathy K, Sahoo A, Pathak NN. Arch Tierernahr. 2001;55(3):243-53

Rotavirus Diarrhea in Children Reduced by Lactobacillus: In a DB PC study, 74 children (ages 4–45 mo) with diarrhea were given either Lactobacillus GG or placebo. Approximately 80% of the children with diarrhea were positive for rotavirus. The duration of diarrhea was significantly shortened (from 2.4 to 1.4 d) in patients receiving Lactobacillus GG. Isolauri E., Juntunen M., Rautanen T., Sillanaukee P., Koivula T. A human Lactobacillus strain (Lactobacillus casei sp strain GG) promotes recovery from acute diarrhea in children. Pediatrics 1991;88:90-97

Rotavirus Less with Breast Feeding than with Lactobacillus: In a DB PC study of 220 children ages 1-18 months, 25% of those given Lactobacillus GG had a rotavirus infection vs. 30% on placebo, not a significant difference. However, only 11% of breast fed vs. 32% of those not breast fed had such an infection. Effect of Lactobacillus GG and breast-feeding in the prevention of rotavirus nosocomial infection. Mastretta E, Longo P, Laccisaglia A, Balbo L, Russo R, Mazzaccara A, Gianino P. J Pediatr Gastroenterol Nutr. 2002 Oct;35(4):527-31. Ed: Breast-feeding is excellent.  However, the Lactobacillus group might have done better using yogurt instead of capsules.

Thomas E. Radecki, M.D., J.D.

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