Probiotic Use Among Older Care Home Residents Does Not Reduce Antibiotic Use

Probiotics may not be an effective option for reducing antibiotic administration in older adults living in care homes, according to a new study.

The study, published in JAMA Network, included 310 participants aged 65 and older at 23 care homes in the UK receiving a daily combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 or a placebo for up to a year between December 2016 and May 2018.

“The particular probiotics we studied, if taken daily by care home residents, did not prevent infections or reduce antibiotic use,” lead author Christopher C. Butler, MD, professor of primary care in the Nuffield Department of Primary Care, professional fellow at Trinity College and clinical director of the University of Oxford Primary Care Clinical Trials Unit, told Contagion^®.

The study, known as the PRINCESS trial (Probiotics to Reduce Infections in Care Home Residents), was led by University of Oxford investigators along with collaborators at Cardiff University and the University of Southampton.

The average age of participants was 85.3, and 66.8% were women. About 63% of participants (195) completed the trial. Participants in the probiotic group required antibiotics to treat infections for an average of 12.9 days compared with 12 days for those in the placebo group. Participants in the probiotic group received antibiotics for lower respiratory infections for an average of 6.2 days compared with 4 days for those in the placebo group.

There were 94 hospitalizations and 33 deaths in the probiotic group compared with 78 hospitalizations and 32 deaths in the placebo group.

“I was hoping to identify a cheap, safe, and effective antibiotic stewardship intervention that worked naturally to enhance immunity in the frail elderly,” Butler said. “It did not work out that way. We need to let the science speak. These findings will re-focus research and guide people's decisions about taking these probiotics for this purpose and in this context.”

Care home residents, who are susceptible to infection, receive more antibiotics than others, and investigators are keen to find alternatives to reduce antibiotic administration and the adverse effects that go along with them, such as antibiotic-associated diarrhea and antimicrobial resistance.

Butler noted that the findings of the study don’t rule out the possibility that other probiotics might be beneficial or that those probiotics studied might be beneficial under other circumstances.

“We are now looking at the stool samples we obtained to explore the relationship of the gut microbiome, antibiotic use, and probiotic use,” Butler said.

Research into probiotics has shown mixed results, with some recent studies challenging widely accepted ideas about the possible benefits of probiotics.

A recent study of predictors of recurrence of Clostridium difficile infections (CDI) found that use of probiotics was associated with an increased risk for CDI recurrence. The study authors said that surprising finding could possibly be explained by physicians prescribing probiotics for some patients at an increased risk for recurrence.

A pair of studies published in 2018 contradicted the idea that probiotic supplements are helpful to children with gastroenteritis, finding that probiotic supplements were ineffective at reducing diarrhea and vomiting in children with gastroenteritis.

Another 2 studies cast doubt on the benefits of giving probiotics after antibiotics, finding that some patients showed resistance to probiotics colonizing their GI tracts and others that received probiotics didn’t see a return to a normal microbiome and gut gene expression profile.