Should I prescribe Lactobacillus to a patient taking Omnicef (Cefdinir)?

Lactobacillus Supplementation with Omnicef (Cefdinir)

Prophylactic probiotics may be considered for patients receiving Omnicef (cefdinir) to reduce the risk of Clostridioides difficile infection, particularly in high-risk settings or during outbreaks. 1

Rationale for Probiotic Use with Antibiotics

• Antibiotics like cefdinir can disrupt normal gut flora, potentially leading to antibiotic-associated diarrhea and C. difficile infection 2
• Certain probiotics have shown efficacy in preventing C. difficile infection when administered concurrently with antibiotics 1
• The efficacy of probiotics is both strain-specific and disease-specific, meaning not all probiotics are equally effective 1

Recommended Probiotic Strains

If considering probiotic supplementation with Omnicef, the following specific strains/combinations have shown evidence of benefit:

• Saccharomyces boulardii 1
• Two-strain combination of Lactobacillus acidophilus CL1285 and Lactobacillus casei LBC80R 1
• Three-strain combination of L. acidophilus, L. delbrueckii subsp bulgaricus, and Bifidobacterium bifidum 1
• Four-strain combination of L. acidophilus, L. delbrueckii subsp bulgaricus, B. bifidum, and Streptococcus salivarius subsp thermophilus 1

Important Considerations and Cautions

• Probiotics are contraindicated in immunocompromised patients due to the risk of bacteremia or fungemia 1
• The American Gastroenterological Association (AGA) provides only a conditional recommendation for probiotic use with antibiotics, citing low quality of evidence 1
• The Infectious Diseases Society of America (IDSA) states there are insufficient data to recommend probiotics for primary prevention of C. difficile infection outside of clinical trials 1
• Probiotics should be administered during the course of antibiotic therapy and can be continued for the duration of antibiotic treatment 1

Clinical Decision Algorithm

1. Assess patient risk factors for C. difficile infection:

   • High-risk: elderly, prolonged hospitalization, severe underlying illness, previous C. difficile infection 1
   • Low-risk: otherwise healthy outpatients 1

2. Screen for contraindications to probiotic use:

   • Immunocompromised status 1
   • Risk of bacteremia or fungemia 1
   • Severe illness 1

3. If probiotic is appropriate, select one of the recommended strains/combinations listed above 1

4. Timing of administration:

   • Start probiotic at the beginning of antibiotic therapy 1
   • Continue for the duration of antibiotic treatment 1
   • Consider continuing for 1-2 weeks after antibiotics are completed 1

Evidence Quality and Limitations

• The overall quality of evidence supporting probiotic use with antibiotics is rated as low 1
• Many studies on probiotics have methodological limitations including heterogeneity in populations, probiotic strains, and outcome measures 1
• The beneficial effect of probiotics is most pronounced in high-risk populations and settings 1
• Publication bias may exist, as many registered trials on this topic were not linked to subsequent publications 1

In summary, while not universally recommended, certain probiotics may be beneficial when administered concurrently with Omnicef (cefdinir), particularly in patients at higher risk for C. difficile infection. The decision should weigh potential benefits against costs and the small risk of adverse effects.