- 期刊
以實證醫學方法探討益生菌改善抗生素引起腹瀉之效果
The Effect of Probiotics on Improving Antibiotic-Associated Diarrhea (AAD): An Evidence Based Medicine Review
摘要
腹瀉為許多常用抗生素的副作用，而年紀較大或長期使用抗生素的住院病人，可能因腸道中困難梭狀桿菌大量增生，造成感染性大腸炎及腹瀉或困難梭狀桿菌相關腹瀉（Clostridium difficile associated diarrhea, CDAD）。益生菌可藉由改善腸道內微生物菌叢的生態平衡而促進宿主健康。近年有許多探討益生菌與抗生素引起腹瀉的相關文獻，本篇文章的目的是以實證醫學之方法了解益生菌對於改善抗生素引起腹瀉之相關研究證據，藉此給予病人適切之臨床使用建議。總結系統性回顧文章及隨機控制試驗建議，益生菌對於0-65歲使用抗生素的病人可用來預防或治療抗生素相關性腹瀉（antibiotic-associated diarrhea, AAD）或CDAD，其中有效的菌種包含Lactobacillus、Streptococcus及Saccharomyces酵母屬菌株。但對於65歲以上使用抗生素的住院老年人則較無顯著改善AAD或CDAD的效果。若病人沒有免疫功能低下的問題，則可考慮使用益生菌來降低抗生素造成腹瀉之風險，但需持續監測病人在服用益生菌後是否出現腸胃不適等副作用。
並列摘要
Diarrhea is a common side-effect associated with antibiotic administration, especially in older hospitalized patients. Long-term use of antibiotics may cause intestinal Clostridium difficile colonization resulting infectious colitis or Clostridium difficile associated diarrhea (CDAD). Probiotic administration has been linked to modulation of gut mucosal immunity, barrier function, metabolism and direct interaction with pathogenic bacteria, confer a health benefit on the host. The purpose of this article is to review the literature on the effectiveness of probiotics on improving antibiotic associated diarrhea (AAD) or CDAD, within the conceptual framework of evidence-based medicine. From an evidence-based perspective according to two systemic review and meta-analysis study of randomized controlled trails and one randomized controlled trial, probiotics may be used for treating or preventing AAD or CDAD for patients from 0 to 65 years old. The effective probiotic species include Lactobacillus spp., Streptococcus spp., and Saccharomyces spp. However, more researches may be needed to study the effectiveness of probiotics for patients who are over 65 years old. In conclusion, for the beneficial effect of improving AAD or CDAD, patients who have no immunocompromised problem may use probiotics to reduce the risk of diarrhea with routine monitoring of gastrointestinal side-effects.