Do patients with Urinary Tract Infection (UTI) on intravenous (IV) antibiotics for 10 days still benefit from prophylactic Lactobacillus acidophilus (a probiotic) to prevent Clostridioides difficile (C. diff) infection?

From the Guidelines

Yes, a patient on IV antibiotics for 10 days for a UTI would likely benefit from taking a probiotic containing Lactobacillus acidophilus as prophylaxis against Clostridioides difficile infection (CDI). Probiotics should be started when antibiotic therapy begins and continued for at least 1-2 weeks after antibiotics are completed. A typical regimen would include Lactobacillus acidophilus with 10-20 billion CFUs daily, taken at least 2 hours apart from antibiotic doses.

Key Points to Consider

• Antibiotics can disrupt the normal gut microbiome by killing beneficial bacteria along with harmful ones, creating an environment where C. difficile can flourish 1.
• Probiotics help maintain or restore the balance of gut flora, potentially reducing the risk of CDI 1.
• The American Gastroenterological Association (AGA) suggests the use of certain strains and strain combinations of probiotics, including Lactobacillus acidophilus, in the prevention of C. difficile infection 1.
• While probiotics are generally safe, patients with severely compromised immune systems or central venous catheters should consult their healthcare provider before starting them.
• Probiotics are a preventive measure and not a replacement for appropriate antibiotic stewardship and infection control practices.

Important Considerations

• The evidence for the use of probiotics in preventing C. difficile infection is based on studies with varying populations, including pediatric, adult, and elderly patients, and different antibiotic regimens 1.
• The beneficial effect of probiotics was seen mainly in patients with very high risk of developing C. difficile infection (>15% baseline risk) 1.
• Patients who place a high value on avoiding associated financial cost or potential harms (especially those immunocompromised patients) and who have low risk of developing C. difficile infection (mainly outpatients in the community) may choose not to use any probiotics 1.

From the Research

Urinary Tract Infection (UTI) and Probiotic Use

• The provided studies do not directly address the question of whether patients with UTI on intravenous (IV) antibiotics for 10 days still benefit from prophylactic Lactobacillus acidophilus (a probiotic) to prevent Clostridioides difficile (C. diff) infection 2, 3, 4, 5, 6.
• However, the studies discuss the use of antibiotics for preventing recurrent UTI, the efficacy of low-dose antibiotic prophylaxis, and the safety of intravesical aminoglycoside instillations as prophylaxis for recurrent UTI.
• None of the studies mention the use of probiotics, such as Lactobacillus acidophilus, in conjunction with IV antibiotics for UTI treatment or C. diff prevention.

Antibiotic Prophylaxis for UTI

• Continuous low-dose antibiotic prophylaxis has been shown to reduce the frequency of UTI in adults who perform clean intermittent self-catheterisation 4.
• Antibiotic prophylaxis has also been found to be effective in reducing the rate of UTI during prophylaxis when compared to placebo 3.
• However, the development of antimicrobial resistance is a concern with long-term antibiotic use 4.

C. diff Infection Prevention

• There is no direct evidence in the provided studies to support the use of Lactobacillus acidophilus as a prophylactic measure to prevent C. diff infection in patients with UTI on IV antibiotics.
• Further research is needed to determine the effectiveness of probiotics in preventing C. diff infection in this patient population.