BioGaia (Lactobacillus reuteri) is Not Recommended for Recurrent C. difficile Infection
Fecal microbiota-based therapies, not probiotics like BioGaia (Lactobacillus reuteri), are recommended for recurrent Clostridioides difficile infection after completion of standard antibiotic therapy. 1
Current Recommendations for Recurrent C. difficile
- The American Gastroenterological Association (AGA) suggests fecal microbiota-based therapies (including conventional fecal microbiota transplant, fecal microbiota live-jslm, and fecal microbiota spores live-brpk) upon completion of standard antibiotic treatment for recurrent C. difficile infection 1
- Fecal microbiota-based therapies have shown significantly better prevention of recurrent CDI compared to controls (74.2% vs 51.7%) 1
- Prevention with fecal microbiota-based therapies should be considered after the second recurrence (third episode) of CDI or in select high-risk patients 1
- For immunocompetent adults with recurrent CDI, the evidence supports fecal microbiota-based therapies with a conditional recommendation based on low certainty evidence 1
Why Not Probiotics Like BioGaia?
- There is insufficient evidence to recommend probiotic therapy (including Lactobacillus reuteri) as an adjunct to antibiotic therapy for C. difficile colitis 2
- The Cochrane review found no evidence to support the use of probiotics alone in the treatment of C. difficile colitis 2
- While some probiotics like Lactobacillus rhamnosus GG have shown potential in experimental models, these findings have not translated to clinical recommendations for Lactobacillus reuteri in human recurrent CDI 3
- Current guidelines make no mention of Lactobacillus reuteri (BioGaia) as a recommended treatment for recurrent C. difficile infection 1
Recommended Treatment Approach for Recurrent CDI
- First-line treatment for recurrent CDI should include standard antibiotic therapy with oral vancomycin or fidaxomicin 4
- For prevention of further recurrences, the following options are recommended:
- Fecal microbiota-based therapies should be given after completing antibiotics, with antibiotics ideally stopped 1-3 days before conventional FMT 1, 4
Implementation Considerations
- Proper diagnosis of recurrent CDI requires clinically significant diarrhea (≥3 unformed stools in 24 hours) with confirmatory positive testing within 8 weeks of completing antibiotics for CDI 1
- Alternative diagnoses should be considered if there are atypical symptoms or no response to vancomycin or fidaxomicin 1
- Careful consideration is needed before proceeding with fecal microbiota-based therapies in patients requiring frequent or long-term antibiotics, as ongoing antibiotics may diminish efficacy 1
- In severely immunocompromised patients, fecal microbiota-based therapies are not recommended 1, 4
Conclusion
For patients with recurrent C. difficile infection, the evidence strongly supports the use of fecal microbiota-based therapies rather than probiotics like BioGaia (Lactobacillus reuteri). The British Society of Gastroenterology and Healthcare Infection Society guidelines specifically recommend FMT for patients who have had at least two recurrences of CDI 1, with no mention of Lactobacillus reuteri as an effective alternative.