Probiotics are sometimes seen as innocent “alternative” medicines. They are heavily promoted as “healthy” products. This view may have to be changed, as the results from a surprising clinical trial in the Netherlands show. Cross posted with thanks from DRUGINFO. WB Probiotics have been extensively marketed for a number of ailments, including for use in diarrhoea, allergy prevention, eczema, and to accompany antibiotic use. In many cases there is insufficient scientific research or consensus for the claims being made. In many instances a strain has no efficacy similar to another being investigated. Dosages may be insufficient or gastic juices destroy the probiotic before it reaches its target. A UCT GIT specialist pointed out that in many cases the safety of many of these products have not been adequately tested and led me to this interesting article, also published in the Lancet, which concludes that in patients with predicted severe acute pancreatitis, use of this combination of probiotic strains did not reduce the risk of infections. Probiotic prophylaxis was associated with a more than two-fold increase in mortality and should therefore not be administered in this category of patients. Ned Tijdschr Geneeskd. 2008 Mar 22;152(12):685-96. Republished from: Lancet. 2008 Feb 23;371(9613):651-9. Probiotic prophylaxis in patients with predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. [Dutch] Besselink MG, van Santvoort HC, Buskens E, Boermeester MA, van Goor H, Timmerman HM, Nieuwenhuijs VB, Bollen TL, van Ramshorst B, Witteman BJ, Rosman C, Ploeg RJ, Brink MA, Schaapherder AF, Dejong CH, Wahab PJ, van Laarhoven CJ, van der Harst E, van Eijck CH, Cuesta MA, Akkermans LM, Gooszen HG; Acute Pancreatitis Werkgroep Nederland. Collaborators (43) Afd. Heelkunde, Universitair Medisch Centrum Utrecht, Utrecht. firstname.lastname@example.org OBJECTIVE: To evaluate whether enteral prophylaxis with probiotics in patients with predicted severe acute pancreatitis prevents infectious complications. DESIGN: Multicentre, randomised, double-blind, placebo-controlled trial.
METHOD: A total of 296 patients with predicted severe acute pancreatitis (APACHE II score > or = 8, Imrie score > or = 3 or C-reactive protein concentration > 150 mg/l) were included and randomised to one of two groups. Within 72 hours after symptom onset, patients received a multispecies preparation of probiotics or placebo given twice daily via a jejunal catheter for 28 days. The primary endpoint was the occurrence of one of the following infections during admission and go-day follow-up: infected pancreatic necrosis, bacteraemia, pneumonia,urosepsis or infected ascites. Secondary endpoints were mortality and adverse reactions. The study registration number is ISRCTN38327949. RESULTS: Treatment groups were similar at baseline with regard to patient characteristics and disease severity. Infections occurred in 30% of patients in the probiotics group (46 of 152 patients) and 28% of those in the placebo group (41 of 144 patients; relative risk (RR): 1.1; 95% CI: 0.8-1.5). The mortality rate was 16% in the probiotics group (24 of 152 patients) and 6% (9 of 144 patients) in the placebo group (RR: 2.5; 95% CI: 1.2-5.3). In the probiotics group, 9 patients developed bowel ischaemia (of whom 8 patients died), compared with none in the placebo group (p = 0.004). CONCLUSION: In patients with predicted severe acute pancreatitis, use of this combination of probiotic strains did not reduce the risk of infections. Probiotic prophylaxis was associated with a more than two-fold increase in mortality and should therefore not be administered in this category of patients.