Probiotics use for antibiotic-associated diarrhea: a pragmatic participatory evaluation in nursing homes

• Published in: BMC gastroenterology Vol. 20; no. 1; pp. 151 - 9
• Main Authors: van Wietmarschen, Herman A, Busch, Martine, van Oostveen, Annemiek, Pot, Gerda, Jong, Miek C
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 13-05-2020; BioMed Central; BMC
• Subjects: AAD; Acids; Aged; Aged, 80 and over; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination - adverse effects; Anti-Bacterial Agents - adverse effects; Antibiotic use; Antibiotics; Care and treatment; Ciprofloxacin; Ciprofloxacin - adverse effects; Clavulanic acid; Complications and side effects; Data collection; Decision making; Dehydration; Diarrhea; Diarrhea - chemically induced; Diarrhea - prevention & control; Elderly; Female; Gastroenterology; Health aspects; Homes for the Aged; Humans; Male; Malnutrition; Medical records; Medical research; Netherlands; Nursing home patients; Nursing Homes; Probiotics; Probiotics - therapeutic use; Psychogeriatric conditions; Risk factors; Somatic conditions; Supplements; Treatment Outcome; Urinary tract diseases; Urinary tract infection; Urinary tract infections; Urogenital system; Netherlands; Probiotics; Antibiotic use; Urinary tract infection; AAD; Somatic conditions; Elderly; Psychogeriatric conditions
• ISSN: 1471-230X; 1471-230X
• DOI: 10.1186/s12876-020-01297-w

Antibiotic-associated diarrhea (AAD) occurs in 2-25% of nursing home residents, which may lead to dehydration, malnutrition, severe complications and hospitalizations. Research shows that probiotics can be effective and safe in reducing AAD. However, probiotics are not routinely used in Dutch nursing homes. The objectives of this evaluation were to develop a procedure for the implementation of probiotics to prevent AAD in nursing homes, to evaluate effects on AAD occurrence, and to evaluate the implementation process of probiotics in daily care.
A pragmatic participatory evaluation (PPE) design was chosen, as it seemed a suitable approach for implementation of probiotics, as well as for evaluation of its effectiveness in daily nursing home practice. Probiotics administration was implemented in three nursing homes of the Rivas Zorggroep for residents with somatic and/or psychogeriatric conditions. Ninety-three residents provided data on 167 episodes of antibiotics use, of which 84 episodes that included supplementation with probiotics and 83 episodes with no probiotics supplementation. A multispecies probiotics was administered twice daily upon start of antibiotic treatment, up to 1 week after completing the antibiotics course. The occurrence of AAD was monitored and a process evaluation was conducted to assess facilitators and barriers of probiotics implementation.
The number of episodes with AAD when using probiotics was significantly lower than when no probiotics was used (20% vs 36%; p = 0,022, Chi-square). No significant differences in the occurrence of AAD were found between the residents taking amoxicillin/clavulanic acid or ciprofloxacin. Reported facilitators for implementation were perceived benefits of probiotics and prescription by medical staff. Reported challenges were probiotics intake by residents and individual decision-making as to which resident would benefit from it.
Successful implementation of probiotics demonstrated the prevention of AAD in nursing home residents.
ISRCTN 94786163, retrospectively registered on 3 February 2020.