Patients who are utilizing long-term antibiotic therapy are at greatest risk of developing infection from Clostridium difficile. Chemotherapy, hospitalization, immunosuppression and use of medications for stomach acid reduction also make patients more vulnerable to development of this bacterial infection.

Two antibiotics -- metronidazole and vancomycin -- are utilized as first-line therapies for Clostridium difficile-related diarrhea. However, in some instances, Clostridium difficile infection is refractory to antibiotic use.

In cases of refractory infection, probiotic therapy can be useful. While the exact mechanism that makes probiotic bacteria successful when resolving Clostridium difficile infection is unknown, it is hypothesized that the healthy bacteria introduced through probiotic therapy compete with the infectious pathogens for food sources. Probiotic bacteria also produce bacteriocins, which may aid in killing Clostridium difficile bacteria, and probiotic bacteria stimulate the production of IgA antibodies in the gastrointestinal tract, as well.

When beginning probiotic bacteria therapy for treatment of Clostridium difficile-related diarrhea, patients are advised to take 200 to 250 billion bacteria daily, consuming half of the dose in the morning and half of the dose in the evening. Probiotics should be taken with non-chlorinated water and used either one hour before a meal or two to three hours after a meal. If patients are taking antibiotics in addition to probiotics, the probiotic dose should be spaced as far apart as possible from the dose of antibiotics.

Once patients’ symptoms of gastrointestinal pain and diarrhea begin to resolve, the dose of probiotics used may be lowered to 25 to 50 billion bacteria daily. Patients who have had multiple cases of Clostridium difficile are recommended to take a daily maintenance dose of probiotic therapy after disease treatment to prevent relapse.

Side effects associated with probiotic use are mild and may include bloating, gas and abdominal cramping. While it is important to note that probiotic bacteria are live organisms, risk of infection from probiotic bacteria is rare. Immunosuppressed patients are at greatest risk of developing a secondary infection from probiotic bacteria use.

In addition to treatment of Clostridium difficile infection, probiotics can be used to treat other gastrointestinal disorders, such as Crohn’s disease and irritable bowel syndrome, aiding in digestion and helping to maintain overall gastrointestinal health.

 From the October 24, 2011, Prepared Foods' Daily News.