From the Guidelines
Patients with positive lactoferrin do not automatically need antibiotics, as lactoferrin is a marker of intestinal inflammation, not specifically bacterial infection 1.
Key Considerations
- Lactoferrin can be elevated in various inflammatory conditions like inflammatory bowel disease (Crohn's disease or ulcerative colitis), certain infections (both bacterial and non-bacterial), and other inflammatory gastrointestinal disorders.
- The decision to prescribe antibiotics should be based on the overall clinical picture, including symptoms, other laboratory findings, and potential causes of the inflammation.
- For bacterial infections like Clostridioides difficile or bacterial gastroenteritis, antibiotics may be appropriate, but for inflammatory bowel disease, immunomodulatory medications might be more suitable 1.
Evidence Summary
- A recent study published in Gastroenterology in 2023 found that the sensitivity and specificity of fecal lactoferrin for detecting moderate to severe endoscopically active disease were 83% and 75%, respectively 1.
- However, the GRADE certainty of evidence was rated as VERY LOW due to serious inconsistency and imprecision 1.
Clinical Implications
- Treating based solely on a positive lactoferrin test without considering the underlying cause could lead to inappropriate antibiotic use, contributing to antibiotic resistance and potential side effects without addressing the actual problem.
- A comprehensive clinical evaluation is necessary to determine the appropriate treatment for patients with positive lactoferrin results, taking into account the potential benefits and harms of antibiotic therapy 1.
From the Research
Patients with Positive Lactoferrin and Antibiotic Need
- Patients with positive lactoferrin may require antibiotics, as lactoferrin is a marker of intestinal inflammation and infection 2.
- The use of lactoferrin in combination with antibiotics has been shown to be effective in treating infections, particularly those caused by antibiotic-resistant bacteria 3.
- Lactoferrin has antimicrobial properties, including the ability to bind iron and sequester it from invading pathogens, making it a potential adjunct to antibiotic therapy 4, 5.
Lactoferrin and Antibiotic Resistance
- Lactoferrin has been shown to increase the inhibitory activity of penicillin against penicillin-resistant Staphylococcus aureus strains 3.
- The combination of lactoferrin and penicillin has been found to be more effective than penicillin alone in treating chronic mastitis caused by S. aureus 3.
Clinical Applications of Lactoferrin
- Lactoferrin supplementation has been found to reduce inflammation, improve immune function, and prevent respiratory tract infections in humans 6.
- The use of lactoferrin as a diagnostic tool for pouchitis has been shown to be sensitive and specific, and may remove the need for invasive pouch investigations 2.