Category: Professional Posters
Purpose: Antibiotic-associated diarrhea (AAD) is a significant cause of morbidity within the hospitalized population. Its prevention is important to improving tolerability, adherence, and effectiveness of oral and parenteral anti-infective therapies. The purpose of this study was to compare the efficacy of the combined probiotic regimen of Bifidobacterium, Lactobacillus, and Streptococcus (VSL#3) to Saccharomyces boulardii (Florastor) in the prevention of antibiotic-associated diarrhea (AAD) in a rural inpatient hospital setting.
Methods: This single-centered, retrospective cohort study was approved by the institutional review board. Internal hospital reports were compiled to analyze patients who received VSL#3 in 2019 or Florastor in 2015 and their antibiotic use. Exclusion criteria included patients who were pregnant, had recently received laxatives, were age < 18 years old, had received chemotherapy, were intolerant of oral medications, or had no overlap of antibiotic and probiotic administration. The regimen for VSL#3 was 1 capsule by mouth twice daily and Florastor was 1 capsule (250 mg) by mouth twice daily. Data collected included age, gender, antibiotic and probiotic name, dose, route, frequency, and length of treatment. Patients were classified into probiotic categories and notes were analyzed for bowel patterns, including diarrhea presence, frequency, and its timing in relation to the administration of antibiotics and probiotics. Statistical significance was analyzed via the chi-squared test and association was determined by risk ratio (RR). The student T-test was used to calculate the statistical significance between the associated healthcare expenditures for a 14-day course of probiotic therapy.
Results: In total, 397 patient charts were reviewed; VSL#3 (n=197) and Florastor (n=200). The VSL#3 group had 158 patients meet inclusion criteria, with 4 confirmed AAD outcomes. The Florastor group had 176 patients meet inclusion criteria, with 6 confirmed AAD. The chi-squared test confirmed that there was no statistically significant difference (p = 0.882) in AAD between the two study groups; RR = 0.743 (CI: 0.213 – 2.584). The student T-test confirmed that there was a statistically significant reduction in probiotic treatment cost when using VSL#3 as compared to Florastor (p<0.0001).
Conclusion: The results showed that 2.5% of patients on VSL#3 and 3.4% of patients on Florastor had experienced AAD while inpatient. Our study suggests that VSL#3 and Florastor are equally efficacious when given concurrently with antibiotics in the prevention of AAD. There is a statistically significant reduction in costs associated with the use of VSL#3 ($2654) compared to Florastor ($3400). This data can assist clinicians when choosing probiotics for their patients on antibiotic therapy based on effectiveness, cost, or formulary restrictions.