Inhibition of Clostridium difficile strains by intestinal Lactobacillus species and bifidibacterium species (both lactic acid bacteria) or Saccharomyces species (yeast) (E.g. S. boulardii (Florastor®)) has been clinically shown to shorten the duration of diarrhea.
How do probiotics work against C. Difficile (and other pathogens)?
• Antagonistic/Competitive towards pathogenic bacteria
• Stimulate immune mechanisms of intestinal mucosa
Take a dose of the highest quality supplemental probiotic you can find - it is generally agreed that:
(1) A significant number of microorganisms must be consumed in order to alter the bacterial population in the gut
(2) Several different species of bacteria given simultaneously are preferable to using just one species.
- Be aware that many products:
(i) Contain way too few CFU to amount to a "hill of beans"
(ii) Contain less live microorganisms than claimed on their label
(iii) Contain significantly less live microorganisms than on their production date
- Some notable probiotic supplement choices to fight C. difficile:
• VSL # 3® - contains 450 billion live bacteria per dose;
• Dr. Mercola®Complete Probiotics -high production quality, 70 billion CFU / dose, 10 strains of lactobacillus and bifidobacterium. Cost ~$1/dose;
• Culturelle®(LGG) - 10 billion CFU Lactobacillus rhamnosus strain GG (LGG) + 245g of prebiotic inulin / capsule dose; Vitacost.com Cost ~0.75 / dose. Good survival rate in stomach/bile acid.
• Florastor® -sometimes recommended by doctors, but only contains 5 billion CFU / capsule of Saccharomyces boulardii ; Cost ~0.75 / dose. Some complain of stomach rumblings.
Ensure probiotic supplement is taken at least 2 hours away from taking antibiotics (E.g. Flagyl or Vancocin). Otherwise the antibiotics will destroy too many of the probiotic bacteria;
For more detail on probiotics, see:
For probiotic dosage suggestions against C. difficile:
Antibiotic / Probiotic Therapy Dosages againstC. Difficile Infection
Kefir. This probiotic liquid contains almost 20 strains of lactobacilli and is used against C. Diff
Dosage. 1/2 cup of kefir four times the first day, then 1/4 cup four times a day for about a week. Can make kefir at home or buy ready-to-eat in a grocery store (in the yogurt section) in plain or flavored. Diluting it with water or juice helps it down.
| Resolution of Recurrent Clostridium difficile-associated Diarrhea Using Staggered Antibiotic Withdrawal and Kefir |
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- By Johan S. Bakken, M. D. , Ph. D. Abstract "Eight patients, each of whom experienced recurrent episodes of Clostridium difficile-associated diarrhea, were treated with staggered and tapered oral metronidazole or vancomycin combined with daily intake of kefir, an over-the-counter liquid probiotic dairy product. All eight successfully resolved their infection and did not experience any further diarrhea after completion of treatment. Further studies will be needed to determine whether gradual antibiotic withdrawal combined with kefir is a valuable treatment for recurrent C. Difficile-associated diarrhea." |
Yogurt with active cultures. E.g. Stoneyfield, Dannon. Avoid sweetened yogurt, since sugar is food for pathogenic bacteria.
"Cultured cabbage" or "Kimchi" (one recipe includes chinese cabbage, green onions and ginger root)
Prebiotics (food for probiotics). Research suggests that prebiotics, such asfructooligosaccharides (FOS), may have a role in prevention and treatment of C. difficile infections by helping to restore normal indigenous microflora.
- These naturally occurring, non-digestible food components are fermented in the colon, having these benefits:
• Selectively utilized by beneficial/probiotic bacteria already in the colon to promote their growth and colonization - thereby having a role in preventing/treating C. difficile infections;
• Normalize bowel function - may be used to manage diarrhea and constipation
| Effect of the prebiotic oligofructose on relapse of Clostridium difficile-associated
diarrhea: a randomized, controlled study. |
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We set out to determine if the prebiotic oligofructose could alter the fecal bacterial flora and, in addition to antibiotic treatment, reduce the rate of relapse from C difficile infection. Consecutive inpatients with C difficile-associated diarrhea (CDAD) were randomly allocated to receive oligofructose or placebo for 30 days in addition to specific antibiotic treatment. Patients were followed up for an additional 30 days. The main end point was the development of further diarrhea. Stools were collected for bacterial culture and C difficile toxin measurement. Fecal cultures confirmed the prebiotic effect of oligofructose. Patients taking oligofructose were less likely to develop further diarrhea than those taking the placebo. Clin Gastroenterol Hepatol. 2005. Department of Medicine, DerrifordHospital, Plymouth, UK
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-Fructooligosaccharides (FOS) are the major class of prebiotics. Found in chicory, garlic, onion, wheat, rye, bananas, leeks, tomatoes and honey. Other prebiotics include inulin and oligolactulose.
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