Using probiotics to reduce risk of diarrhoea when taking antibiotics

Morgan Liotta

18/02/2020 1:31:37 PM

In the first of a series of HANDI updates, newsGP talks to the author of a recently added intervention.

Hand holding probiotic capsule
‘The likelihood of being otherwise harmed by probiotics is negligible,’ says a HANDI clinical expert.

The RACGP’s Handbook of Non-Drug Interventions (HANDI) aims to provide GPs with free, up-to-date and evidence-based interventions that don’t rely on prescribing medicine. HANDI also offers patient resources to assist in their decision making.
Recent updates and new HANDI entries add to the suite of 65 interventions, with more in development and planned to be released on the site over the coming year.
Dr Dan Ewa​ld is a GP, Adjunct Associate Professor from the University of Sydney, and lead author of one of the latest HANDI addition, ‘Probiotics for the prevention of antibiotic-associated diarrhoea in adults and children’.
Antibiotic-associated diarrhoea occurs in 2–15% of people taking antibiotics. The HANDI intervention provides recommendations on reducing risk of an upset stomach in all age groups.
‘Any course of antibiotics could trigger diarrhoea; however, there are some risk factors that will be useful to pick the cases where antibiotic-associated diarrhoea is more likely, or more likely to be particularly problematic,’ Dr Ewald told newsGP.
‘My approach is to mention the potential benefit of taking probiotics with any antibiotics I prescribe. How much I encourage it depends on the presence of the risk factors.’ 
Dr Ewald cites risk factors to include longer courses of antibiotics, use of certain types of antibiotics, or multiple use. Patients who are otherwise frail or immunocompromised are also more at risk.

‘The meta-analysis of randomised controlled trials showed a clearer benefit for those patients groups with a baseline risk [control group incidence] of 5% or more,’ he said.
‘The use of the risk factors can help us find the higher risk patients.’
The main barriers for people taking probiotics are cost and hassle, according to Dr Ewald, but there is relatively low risk.
‘The likelihood of being otherwise harmed by probiotics is negligible, [although] I would be very cautious in someone heavily immunosuppressed, though they would be under specialist care,’ he advised.
HANDI recommends probiotics can be taken during and/or after antibiotic dosing, with use for the minimum of the antibiotic treatment duration sufficient, although dose duration was variable across different studies identified during development of the intervention.
‘The details of how long to use [probiotics] is not well defined by the current literature; however, there is probably quite a bit of latitude possible there,’ Dr Ewald said.
‘There have been a number of studies seeking to clarify which probiotic species are most beneficial – these are mentioned in the HANDI topic details.’ 
Probiotics are available in the form of drinks, capsules and powders from supermarkets, pharmacies and health food stores.
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antibiotics diarrhoea HANDI non-drug interventions probiotics

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Dr Adele Frances Stewart   19/02/2020 7:52:35 AM

My understanding was that the type of probiotic was vital?

Dr Lee Chen Tay   19/02/2020 10:36:37 AM

why not make HANDI an app?
app is more user friendly than needing to have access to computers/websites/logins.

A.Prof Christopher David Hogan   19/02/2020 12:20:07 PM

Technology has now advanced to a level where Australians have developed a mechanism of doing a DNA analysis of a patient's gut biome in 7 days. This overcomes the limitation of microscopy & culture as far too many gut organisms as fastidious & extremely hard to identify