Routine use of probiotics with antibiotic therapy

Dr Paul Moayyedi is a professor in the Division of Gastroenterology at McMaster University, Richard Hunt/AstraZeneca Chair in Gastroenterology, and the inaugural assistant dean of research.

Should probiotics be used routinely in all patients treated with antibiotics?

Paul Moayyedi, BSc, MB ChB, PhD, MPH: I would say no. Of course, antibiotic-associated diarrhea is a risk, but this does not affect everyone. Probiotics in randomized trials do reduce the risk, but for most people this is not a major thing. Therefore, to do this in everyone is probably not cost-effective.

In people at high risk of Clostridioides (Clostridium) difficile and high risk of severe antibiotic-associated diarrhea, the very elderly, the ill, that is certainly something that could be considered. But it should not be routine in my view.