No clear benefit to daily probiotics for reducing antibiotic use among elderly care home residents

Reference

Butler CC, Lau M, Gillespie D, et al. Effect of probiotic use on antibiotic administration among care home residents. A randomized clinical trial. JAMA 2020;324(1):47-56.

Synopsis

These investigators identified elderly residents, 65 years or older (mean age 85.3 years), living in UK residential homes or nursing homes that provide residents with 24-hour support for personal care or nursing care. Study participants randomly received (concealed allocation assignment) a daily oral probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 or a matched placebo. Individuals masked to treatment group assignment recorded pertinent outcomes, including the amount of product consumed daily, the use of antibiotics, any signs of infection, diarrhea, hospitalization, and serious adverse events including death. Of the initial 310 care home residents randomized at baseline, 195 (62.9%) remained alive and completed the 12-month trial. Using intention-to-treat analysis, no significant group differences occurred in the primary outcome of cumulative systemic antibiotic administration days. Care home residents randomized to receive the daily oral probiotic combination received significantly more antibiotics for lower respiratory tract infections, but no significant group differences occurred in antibiotic use for urinary tract infections, upper respiratory tract infections, or skin infections. There were also no significant group differences in hospitalizations, diarrhea, stool samples positive for Clostridium difficile, or all-cause mortality. The study was 90% powered to detect a predetermined clinically significant group difference in antibiotic administration.