Running head: PROBIOTICS TO TREAT ANTIBIOTIC ASSOCIATE

Probiotics to Treat Antibiotic Associated Diarrhea

Katelyn Gaffney
Ferris State University

PROBIOTICS TO TREAT ANTIBIOTIC ASSOCIATE

Abstract
Do probiotics prevent and/or treat antibiotic associated diarrhea in patients? Many patients stop
the antibiotic they are on to prevent them from getting diarrhea, which is a common side effect of
antibiotics. Health care providers recommend that patients take probiotics to help treat and/or
prevent antibiotic associated diarrhea from occurring. A systematic review was conducted to
evaluate if probiotics are an effective use of prevention and/or treatment to antibiotic associated
diarrhea. Two independent reviewers evaluated 82 randomized controlled trials from 12
different electronic database searches. Through this evidence based research, it is suggested that
probiotics is an effective way to treat and/or prevent antibiotic associated diarrhea from
occurring but there needs to be more studies conducted to find which strains of probiotics work
the best.

PROBIOTICS TO TREAT ANTIBIOTIC ASSOCIATE

Probiotics to Treat Antibiotic Associated Diarrhea

Health care providers prescribe antibiotics to patients to treat multiple illnesses.
Antibiotics though, cause many side effects. Diarrhea is one of the most common side effects.
Probiotics can be prescribed to treat this antibiotic associated diarrhea (AAD). Through evidence
based research, nurses can reassure parents that probiotics are an effective treatment for AAD.
Background
Antibiotics are prescribed to patients to treat multiple illnesses. These antibiotics cause
multiple unwanted side effects. Diarrhea is the most common unwanted side effects. This occurs
because the purpose of antibiotics is to kill and fight off the bad bacteria in the body. While the
antibiotic is killing and fighting off the bad bacteria it can also kill the natural flora (good
bacteria) in the digestive tract. Probiotics are used to help keep and replenish that natural flora.
Probiotics are live microorganisms intended to confer a health benefit when consumed
(Hempel, 2012). In this study, probiotics are being researched to see if they are an effective way
to treat and/or prevent AAD.
Study
First, the study is a systematic review and meta-analysis of parallel randomized
controlled trials (RCTs) that were receiving no treatment, a placebo, a different probiotic or
probiotic dose. Twelve different electronic databases (DARE, Cochrane Library of Systematic
Reviews, CENTRAL, PubMed, EMBASE, CINAHL, AMED, MANTIS, TOXLINE, ToxFILE,
NTIS, and AGRICOLA), clinicaltrials.gov and International Journal of Probiotics and Prebiotics
were searched to find independent studies done on probiotics used to treat AAD. The search
criteria were broad and open to many possibilities. The search was not limited on age, patients

PROBIOTICS TO TREAT ANTIBIOTIC ASSOCIATE

symptomatology, which type of probiotic intervention used, if probiotic was given alongside
antibiotic, and any forms of diarrhea reported.
Second, the publications were reviewed and assessed by two independent reviewers.
Two independent reviewers extracted trial details pertaining to the participants, antibiotics and
probiotics interventions and comparators, and results regarding diarrhea, using a standardized
form. Discrepancies were resolved through discussion (Hempel, 2012). Even though the main
outcome being looked at was the number of participants with diarrhea in each treatment group,
the reviewers also looked for similar outcomes like severity and consistency of the stool. After
the trials were chosen, they were put through a bias test and combined into a random-effects
meta-analysis to calculate any risk. Finally, the trails remaining trials were reviewed and the
results of the trials were combined and put into a systematic review.
Results
After all the trials were reviewed and assessed, 82 RCTs met the final criteria. The
review found that Lactobacillus was the probiotic that was used in majority. The lactobacillus
was either used alone or in combination with other genera but the strains was poorly
documented. Though, 63 of the RCTs found that there was a significant association of probiotic
administration with reduction in AAD (Hempel, 2012). The study concluded that probiotics are
related to a decrease in AAD but there needs to be more research conducted in order to
determine which probiotics provide the maximal efficacy and which probiotics work best with
which antibiotics.
Limitations

PROBIOTICS TO TREAT ANTIBIOTIC ASSOCIATE

This study has very minimal limitations, if any due, to the fact that it is a systematic
review and meta-analysis (which is the highest form of research conducted) and limitations are
eliminated during the review process.
We applied the Cochrane Risk of Bias tool to assess sequence generation;
allocation concealment; participant, personnel, and outcome assessor blinding;
attrition bias; incomplete outcome data; selective outcome reporting; and other
sources of bias.12 In addition, we assessed the reporting and ascertainment of
included strains, the statistical power, and the funding and potential for conflict of
interest associated with individual trials (Hempel, 2012).
The trials were also put into a random-effects meta-analysis which calculated the relative risk.
The analysis also looked for any sensitivity and did a subgroup analysis.
Population difference
Since this is a systematic review, it looks at multiple independent studies that have a wide
variety in the population sample. The results are the same for every age, gender and ethnicity.
When it comes to nursing care for patients with diarrhea from an antibiotic it is still
recommended to give a probiotic to help prevent and treat the AAD. A nurse can give a patient
food that provides probiotics, such as yogurt, to help with the diarrhea or the nurse can
administer probiotics in medication from, as long as there is an order to any type of population.
There is no comparison in populations when it comes to a nurse giving probiotics to treat AAD.
Plan of Care

PROBIOTICS TO TREAT ANTIBIOTIC ASSOCIATE

The primary problem in the study is diarrhea. Even though it is looking specifically
looking at AAD and how effective probiotics are at preventing and treating AAD. There are
three main nursing diagnoses for diarrhea: 1) diarrhea, 2) deficient fluid volume and 3) risk for
electrolyte imbalance.
The first nursing diagnosis is diarrhea r/t medication adverse effect. A patient outcome
would be to defecate formed, soft stool every one to three days. One nursing intervention would
be to consult the physician to get an order to give probiotics and/or fiber. After order is given,
administer the probiotic and/or fiber to the patient. Another nursing intervention would be to
monitor and assess the patients stool after every bowel movement, using a hat that is placed in
the toilet, to see any change in stool form and consistency.
The second nursing diagnosis is deficient fluid volume r/t excessive loss of fluids from
liquid stools. A patient outcome would be to maintain a urine output of 0.5 mL/kg/hour. One
nursing intervention would be to monitor fluid intake and output every four hours. Another
nursing intervention would be to get an order for an isotonic IV solution from the physician and
administer it to the patient once ordered or have the patient drink a minimum of six to eight eight
ounce glasses of water.
The third nursing diagnosis is risk for electrolyte imbalance. A patient outcome would be
to maintain normal serum potassium, sodium, calcium, phosphorus and pH levels. One nursing
intervention would be to monitor and evaluate laboratory data and report any deviations to the
physician. Another nursing diagnosis would be to get an order for electrolyte replacement
medication if any laboratory data is lower than a normal range and administer those medications
once order is given.

PROBIOTICS TO TREAT ANTIBIOTIC ASSOCIATE

References

Hempel, S., Newberry, S. J., Maher, A. R., Wang, Z., V. Miles, J. N., Shanman, R., & Johnson,
B. (2012, May 9). Probiotics for the prevention and treatment of antibiotic associated
diarrhea: A systematic review and meta-analysis. The Journal of the American Medical
Association, 307(18), 1959-1969. doi:10.1001/jama.2012.3507.

PROBIOTICS TO TREAT ANTIBIOTIC ASSOCIATE

Criteria

Below Expectations

7
Needs Improvement

Meets Expectations

Explains health care/

nursing problem addressed
in study.

(0-3 points)

(3-17 points)

(18-20 points)

Health care problem is not

related to nursing.

Health care/nursing problem is

addressed but could be more
clearly articulated.

Explanation of health care/

nursing problem is accurately
and clearly articulated.

Explains how study was

conducted. Includes
population, type of study,
and what was done to
gather study data.

(0-3 points)

(3-17 points)

(18-20 points)

2 or more parts of study are

not clearly articulated.

One part of study methods is

not clearly articulated.

Methods of study are

accurately and clearly
articulated.

Explains results of study

that provided evidence for
the nursing care.

(1-2 points)

(3-7 points)

(8-10 points)

Weak correlation of study

evidence with nursing care.

Satisfactory correlation of study

evidence with nursing care.

Excellent correlation of study

evidence with nursing care.

Identifies limitations of
study.

(1-2 points)

(3-7 points)

(8-10 points)

Provides only limitations

stated in article.

Recognizes limitations stated in

study article and own analysis is
present but lacks depth and
breadth of thinking.

Recognizes limitations stated

in study article.
Demonstrates critical
thinking when analyzing
evidence.

Explains how nursing care

may differ with another
population or age group.

(1-2 points)

(3-7 points)

(8-10 points)

Demonstrates weak critical

thinking when comparing
nursing care with another
population.

Demonstrates average critical

thinking when comparing
nursing care with another
population.

Demonstrates satisfactory
critical thinking when
comparing nursing care with
another population.

Develops plan of care

correlating multiple factors
in human health and
illness.

(1-2 points)

(3-7 points)

(8-10 points)

Accurately identifies 1
nursing diagnosis with
outcome criteria and
interventions for nursing
care problem addressed in
study.

Accurately identifies at least 2

nursing diagnosis with outcome
criteria and interventions for
nursing care problem addressed
in study.

Accurately identifies at least

3 nursing diagnosis with 1
outcome criteria and at least
2 interventions for nursing
care problem addressed in
study.

Reflects on relevance of
study to actual nursing
practice.

(1-2 points)

(3-7 points)

(8-10 points)

Either relevance or
correlation to nursing
practice weak.

Relevance is accurate with some

correlation to nursing practice.

Relevance is accurate and

relates well to nursing
practice.

Spelling and Grammar.

(1-2 points)

(3-7 points)

(8-10 points)

> 5 misspelled words

and/or grammar errors.

> 2 but < 5 misspelled words

and/or grammar errors.

Only 0-1 misspelled words

and/or grammar errors.