Probiotics for primary prevention of Clostridioides difficile infection: revisiting the evidence

Abstract

Prophylactic probiotics have been shown to be effective in preventing Clostridioides difficile infection (CDI), according to multiple meta-analyses. However, different medical societies have varying recommendations on their use for preventing CDI. In this commentary, we discuss current evidence for probiotic use in primary prevention of CDI and the issues raised by professional societies when evaluating the evidence. We highlight four areas for future improvement: considering baseline risk for CDI, timing of probiotics with antibiotics, combining efficacy data from different probiotic strains, and safety. All societies agree on the need for more high-quality and adequately powered randomized controlled trials to further strengthen the evidence.

Keywords:

• Healthcare-associated infections
• probiotics
• Clostridioides difficile infection
• Clostridioides difficle prevention

Transparency

Declaration of funding

This paper was not funded.

Declaration of financial/other relationships

All authors report no conflicts of interest relevant to this article. AD has received research support from The Clorox Company and Seres Therapeutics; and is a consultant for Merck. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

JF and WP contributed equally to the research and writing. AD was involved in the conception of the work.

Acknowledgements

None.