At a time when antibiotic resistance to bacterium is as prevalent as it is today there is a need to stand back and look at prevention rather than cure. If we don't we run the risk of leaving our children and future generations a legacy that our grandparents faced when there were no antibiotics to rely on.
Antibiotics should be used efficaciously, that is as a last resort when all efforts to prevent an infection occuring have failed. Technologies, both natural and man-made are proven to work in the fight to reduce the risk of acquiring an infection in the healthcare setting, not least the human body's own defence mechanism.
It is widely reported that immune suppressed patients are more susceptable to healthcare infections, although we know from bitter experience young, fit healthy people have contracted infections which have killed and maimed. I believe that if we are to give everyone a chance of making a good recovery from any surgical procedure then we should look at the armoury we have to protect ourselves from the risks of infection. A lot of people are regularly taking probiotics in their diets as they have looked at the research, and this has been backed up recently in the BMJ, and they are safeguarding themselves for whatever eventually they may have to face in terms of staying healthy. Taking probiotics regularly can help to shore up the system to help you fight infection naturally. If you do succumb to an infection during a surgical procedure and antibiotics are given then the probiotics can help with balancing your own immune system.
Research has shown that even when probiotics are capable of establishing a colony of beneficial bacteria of the large gut it has to be regularly topped up with fresh beneficial bacteria - if it is to retain the foothold it has established. This may mean taking the probiotics at least daily and in some cases a twice daily regime is recommended.
The advantages are that once the beneficial bacteria are established from the probiotic the gut is likely to work better, nutrients will be more easily absorbed, vitamin production will be unaltered and, unwelcome gut symptoms such as irritable bowel syndrome will be lessened in many cases, ultimately resulting in the patient's immune system and defence against infections being enhanced.
Probiotics may have a special role when antibiotics have been prescribed. They reduce the chance of other infections settling in the gut after the antibiotic has upset the patient's usual gut flora. Implanting beneficial bacteria may prevent these antibiotic induced gut changes leading to serious disease. Some hospitals are now giving probiotics to patients to bolster the gut's normal flora. They've also been used to manage recurrent infection with C.Diff. The probiotics most frequently used to treat C.Diff include Lactobacillus GG, which is a concentrate that can be added to skimmed milk and Lactobacillus acidophilus, found in yogurt.
I believe that in the battle against ever prevalent healthcare infections we should be relying on our bodies natural defenses to antimicrobial resistance more and more, and making the best use of natural technology to help this process.
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9 comments:
I know of someone who took probiotics on a daily basis as part of their normal regime of healthy eating. When they went into hospital this stopped, they became poorly with an infection and pneumonia, contracted cdiff and sadly passed away. There was poor infection control with other cases of cdiff on the ward. Tragic.
This should not be viewed as a panacea for reducing the risks to infection. The recent research cited in the BMJ (Mary Hickson) was conducted in a controlled group where patients on the higher risk antibiotics were used, and the cost benefits have been challenged. There is other robust research out there that suggests probiotics can reduce the incidence of diarrohea including C.Diff in some patients. Therefore if patients want to take the probiotic yoghurt then this should be made available to them, there are some patients that may not get any benefit from this treatment however. There was no mention of levels of CDiff in the environment where this control group was trialed. One would hope that infection control was exemplary to avoid any external factors contributing to the group of people who did go on to contract CDifficile diarrhea.
There should be further research before recommending that patients over 50 should be prescribed probiotics as a matter of course.
Certainly, the use of any technology should not be seen as a panacea to the fight against healthcare infections. There are many tools that should be used in the armoury for prevention of infection rather than cure. Probiotics and a healthy diet can help to shore up the immune system, and some of the probiotic yoghurt on the market is very palatable particularly to those who may have a poor appetite.
Overuse of broad spectrum antibiotics particularly those that there were not included in the trial such as cephalosporins, should be avoided, and strict infection control regimes followed. There are some patients as you rightly say that merit careful consideration for the use of probiotic supplements, particularly those with any form of immune deficiency. Further trials to broaden the control group may provide more answers, but do we really want to subject patients to trials where high risk antibiotics are used, such as cephalosporins, when we are trying to discourage their use?
See the research outlining the risks referred to:
“Probiotics have been advocated for the prevention and treatment of a wide range of diseases, and there is strong evidence for their efficacy in some clinical scenarios. Probiotics are now widely used in many countries by consumers and in clinical practice. Given the increasingly widespread use of probiotics, a thorough understanding of their risks and benefits is imperative. Although probiotics have an excellent overall safety record, they should be used with caution in certain patient groups—particularly neonates born prematurely or with immune deficiency. Because of the paucity of information regarding the mechanisms through which probiotics act, appropriate administrative regimens, and probiotic interactions, further investigation is needed in these areas. Finally, note that the properties of different probiotic species vary and can be strain-specific. Therefore, the effects of one probiotic strain should not be generalized to others without confirmation in separate studies. Careful consideration should be given to these issues before patients are advised to use probiotic supplements in clinical practice.” Source: Probiotic use in clinical practice: what are the risks? - Robert J Boyle, Roy M Robins-Browne and Mimi LK Tang
I am glad you have cited this research, it cannot be emphasised enough to practioners that giving out probiotics is not going to be a safety net to those in the over 50 age-group where the Mary Hickson research has recommended prescribing the probiotics to these patients.
Sparing use of antibiotics for less serious infections, and strict attention to other infection control measures, such as aseptic technique, stringent hygiene and the use of masks to filter transmission of airborne bugs from healthcare worker to patient and vice versa must be adhered to to make the environment safe for patients.
Your poll is interesting, each vote advocates the use of probiotics whether in a research environment or as part of a national distribution to patients who may benefit from it. The DoH can only recommend tools for the reduction of infection, if trusts decide to spend their budget elsewhere then probiotics would be off the menu for a lot of patients, perhaps the money may be more wisely spent on other measures to reduce infections.
In the light of today’s Maidstone report and the 377 slain by the incompetence and neglect of the regime there, I think that every opportunity should be taken to review what works. Of concern, new questions on the pathogen are arising – is it airborne? There have been suggestions that it may be as it has been found on the tops of curtain rails in some hospital wards. Of further concern is the ignorance of the fact that alcohol gel is ineffective against C.diff spores – could this be a major contributory factor in the inability to have contained this pathogen in Maidstone?
Frighteningly all patients are to be given alcohol gel when they go into hospital – will this give them a false sense of security. Soap and water and proper hand washing technique is essential to keep from ingesting this pathogen. Clipped nails and no hand jewelry in the hospital environment is the preferred method of keeping pathogens such as MRSA and C.diff at bay. Patients can re-infect themselves, yet when do you see this given out in any information leaflets or posters provided by hospitals – I haven’t seen one that says this yet – I would like someone challenge me and prove me wrong – send me one if you’ve seen it.
The use of probiotics to help the body fight off bacteria is something that should be trialled further, I believe in a healthy diet and I have not seen any evidence to suggest that they do any harm, I believe this should be done in consultation with a dietician.
Every hospital should have as part of its team an antibiotic pharmacist, as clearly the over prescribing is having a devastating effect on people’s immune systems.
And of utmost importance is the environment, particularly in relation to C.diff. There needs to be more research done on methods of keeping the pathogens out of the environment, bacteria is constantly evolving and the focus needs to be on prevention and containment.
We all have a part to play in keeping the environment and ourselves hygienically clean, but science and technology needs harnessing to help us combat these lethal pathogens and save lives.
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