Antibiotic-associated Diarrhea in Elderly Patients with Community-acquired Pneumonia: The Impact of Probiotics on Prevention and Treatment
DOI:
https://doi.org/10.52340/GBMN.2025.01.01.99Keywords:
Antibiotic-associated diarrhea (AAD), community-acquired pneumonia, elderly patients, gut dysbiosis, Lacto-G Forte, probioticsAbstract
Background: Community-acquired pneumonia is common in the elderly because of decreased immune function. Using broad-spectrum can lead to gut dysbiosis and antibiotic-associated diarrhea (AAD). Co-administration of probiotics during antibiotic treatment is a reasonable way to prevent AAD. The clinical application of probiotics is mainly related to improving gastrointestinal symptoms; they reduce the overgrowth of potentially pathogenic microorganisms, improve gut mucosal barrier function, reduce bacterial translocation, and reduce toll-like receptor-mediated up-regulation of immune function. Objectives: This study aimed to investigate the clinical value of probiotic treatment in elderly patients with pneumonia. Methods: We studied 85 elderly patients diagnosed with community-acquired pneumonia. The patients were divided into the probiotic and control groups and treated according to the pneumonia treatment guidelines. In the probiotic group, Lacto-G forte (Lactobacillus acidophilus, Bifidobacterium longum, Bifidobacterium bifidum, Bifidobacterium lactis) was used, while patients of the control group received a placebo. Frequency of ADD, length of hospital stays, duration of antimicrobial therapy, stool qualitative and quantitative characteristics, days till stool normalization, and safety profile were registered during the study. Results: Antibiotic-associated diarrhea in the Lacto-G Forte group was 12 cases - 27.9%, i.e., experimental event rate (EER)=0.279, and in the control group, was 26 cases - 61.9%, i.e., control event rate (CER) = 0.619. In the Lacto-G Forte group, compared to the placebo group, there was a 55% reduction in relative risk, or relative risk reduction (RRR) = 0.55, and a 34.0% reduction in absolute risk, or absolute risk reduction (ARR) = 0.34. NNT analysis of data from the probiotic and placebo groups revealed that the number needed to treat is 3. The average time to resolve diarrhea in the Lacto-G Forte group was 1.38±0.62 days, and in the placebo group - 2.37±0.84 days. Conclusions: Lacto-G Forte supplementation in elderly patients with community-acquired pneumonia reduces the risk of developing antibiotic- associated diarrhea and can resolve it quickly.References
Hospitalized patients of both genders aged ≥60 years receiving oral or parenteral antimicrobial therapy because of community-acquired pneumonia;
Duration of antibiotic treatment ≤48 hours.
Diarrhea at the moment of hospitalization or within the last week before hospitalization;
Chronic disease with recurrent diarrhea;
Antimicrobial therapy taken/ongoing within the last 4 weeks before hospitalization;
Regular intake of probiotics/eubiotics/symbiotics;
Lactose intolerance;
Taking laxatives.
Complete blood count (CBC);
Determination of serum electrolyte concentrations;
Quantitative determination of C-reactive protein (CRP);
Determination of serum thyroid-stimulating hormone (TSH) concentration;
Determination of serum free thyroxine (FT4) concentration;
Coprological analysis for Clostridioides difficile toxins: Glutamate dehydrogenase (GDH) antigen test; Toxin A and B test; If necessary (GDH-positive/toxin-negative or GDH-negative/toxin-positive): nucleic acid amplification test (NAAT);
Glutamate dehydrogenase (GDH) antigen test;
Toxin A and B test;
If necessary (GDH-positive/toxin-negative or GDH-negative/toxin-positive): nucleic acid amplification test (NAAT);
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