Effect of Probiotic Formula on Reducing the Risk for Antibiotic-associated Diarrhoea

Antibiotic treatment disturbs the balance of the intestinal microbiota and predisposes to antibiotic associated diarrhea. Previous studies have shown that the risk of developing diarrhea during a course of antibiotics may be reduced by simultaneous consumption of probiotics. The aim of the present study is to assess the effect of a probiotic formula containing four strains on reducing the risk of antibiotic associated diarrhea.

Study Overview

• Status: Terminated
• Conditions: Antibiotic-associated Diarrhoea
• Intervention / Treatment: Dietary supplement: Probiotic; Dietary supplement: Placebo

Detailed Description

The aim of the study is to assess the effect of a probiotic formula on reducing the risk of antibiotic-associated diarrhea (AAD). The study will be conducted as a two-arm, parallel groups, placebo-controlled, double-blind, randomized clinical trial, stratified by age, gender and number of days on antibiotics. The duration of patient participation in the study will be up to 7 weeks (up to 3 weeks supplementation, 4 weeks follow-up). The overall duration of the study is expected to be approximately 8 months. Adult males and females that are prescribed antibiotic therapy for minimum of 3 and a maximum of 14 days will be included in the study. The incidence of AAD will be evaluated as the primary end-point. The stool from patients presenting diarrhea will be tested for the presence of Clostridium difficile and if negative for C. difficile, also for the presence of other common pathogens causing diarrhea. The overall microbiota will be analyzed from fecal samples taken regularly during each phase of the study.

• Study Type: Interventional
• Enrollment (Actual): 258
• Phase: Phase 2; Phase 3

Contacts and Locations

Study Locations

• Finland
  • Tampere, Finland
    • Koskiklinikka

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Males and females aged 18-65 years.
2. Patients will be initiating antibiotic therapy.
3. The antibiotic therapy consists of one of the following: broad spectrum penicillins, cephalosporins, doxycycline, clarithromycin, ciprofloxacin or isoxazolyl penicillin.
4. The antibiotic therapy is expected to be 3 to 14 days in duration.
5. Obtained his/her informed consent after verbal and written information.
6. Have a high probability for compliance with and completion of the study.
7. Patients having a telephone available.
8. Body Mass Index between 19 and 30.

Exclusion Criteria:

1. Participation in a clinical trial with an investigational product or drug within the 60 days prior to screening.
2. Likeliness to be noncompliant with the protocol, or to be unsuitable to the study by the investigator for any reason.
3. Pregnant or breastfeeding women; women planning to become pregnant during the study months.
4. Presence of active diarrhea (3 or more loose or watery stools per 24 hour period).
5. Daily consumption of probiotics, fermented milk and/or yogurt with probiotics.
6. Known to have a previous reaction, including anaphylaxis, to any substance in composition of the study product (i.e. on-medicinal ingredients: Cellulose, hypromellose, magnesium stearate (vegetable source), ascorbic acid, Colloidal silicon dioxide).
7. Presence of an active, non-controlled intestinal disease such as Crohn's Disease or ulcerative colitis.
8. Regular use of proton pump inhibitors.
9. Bowel surgery, artificial heart valve, history of rheumatic heart disease or infective endocarditis.
10. A previous documented C. difficile infection < 3 months prior to study initiation.
11. Immunosuppressive therapy or any health condition causing immunosuppression (including haematological malignancies, AIDS).
12. Ongoing or recent use of antibiotic therapy in the 3 months prior to the study product first administration.
13. Planned administration of antibiotics other than broad spectrum penicillins, cephalosporins, doxycycline, ciprofloxacin or isoxazolyl penicillin for the treatment of an infection.
14. History of drug or alcohol abuse.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: SUPPORTIVE_CARE
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: QUADRUPLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
ACTIVE_COMPARATOR: Probiotic; Probiotic consumption during and after course of antibiotic	Dietary supplement: Probiotic; Probiotic formula, 10 billion CFU in total once a day for up to 3 weeks; Other Names: Howaru Restore
PLACEBO_COMPARATOR: Placebo; Placebo consumed during and after course of antibiotic	Dietary supplement: Placebo; A capsule with microcrystalline cellulose matching the appearance and taste of the active comparator; Other Names: Microcrystalline cellulose as placebo

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of AAD	Incidence of diarrhoea defined as three or more loose or watery stools per a 24 h period.	Up to 21 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Duration of diarrhoea	Number of continuous days of diarrhoea	Up to 21 days
Fecal microbiota	Analysis of overall microbiota from all samples and of causative diarrhoeal agent from samples taken during diarrhoeal episode	Up to 21 days
Safety profile	Evaluation of serious and non-serious adverse events	Up to 21 days

Collaborators and Investigators

• Sponsor: Danisco
• Investigators: Principal Investigator: Toivo Piippo, MD, Koskiklinikka Tampereen Lääkärikeskus Oy; Study Chair: Anneli Tarpila, PhD, Danisco

Publications and helpful links

General Publications

• Forssten SD, Yeung N, Ouwehand AC. Fecal Recovery of Probiotics Administered as a Multi-Strain Formulation during Antibiotic Treatment. Biomedicines. 2020 Apr 9;8(4):83. doi: 10.3390/biomedicines8040083.

Study record dates

Study Major Dates

• Study Start: December 1, 2012
• Primary Completion (ACTUAL): December 1, 2014
• Study Completion (ACTUAL): December 1, 2014

Study Registration Dates

• First Submitted: May 8, 2012
• First Submitted That Met QC Criteria: May 9, 2012
• First Posted (ESTIMATE): May 11, 2012

Study Record Updates

• Last Update Posted (ESTIMATE): January 22, 2016
• Last Update Submitted That Met QC Criteria: January 21, 2016
• Last Verified: December 1, 2014

More Information

Terms related to this study

• Keywords: probiotic; antibiotic; antibiotic-associated diarrhoea; faecal microbiota
• Additional Relevant MeSH Terms: Signs and Symptoms, Digestive; Diarrhea
• Other Study ID Numbers: AAD-EU2012; 2012-001542-18 (EUDRACT_NUMBER)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Terminated prematurely.