Probiotic prophylaxis of no benefit for predicted severe acute pancreatitis

[News Feeder14]

A study published early online in the Lancet has examined whether enteral administration of probiotic prophylaxis in patients with predicted severe acute pancreatitis can reduce infectious complications and associated mortality.

The study involved 298 patients (APACHE II score = 8, Imrie score = 3, or CRP >150 mg/L) who were randomised to within 72 hours of onset of symptoms to receive a multispecies probiotic (Lactobacillus acidophilus, Lactobacillus casei, Lactobacillus salivarius, Lactococcus lactis, Bifidobacterium bifidum, and Bifidobacterium lactis) preparation (n=153) or placebo (n=145), administered enterally twice daily for 28 days. The primary endpoint was the composite of infectious complications (infected pancreatic necrosis, bacteraemia, pneumonia, urosepsis, or infected ascites) during admission and 90-day follow-up. According to the intention to treat analyses:

• Infectious complications occurred in 46 (30%) patients in the probiotics group and 41 (28%) of those in the placebo group (relative risk 1.06, 95% CI 0.75 to 1.51).
• 24 (16%) patients in the probiotics group died, vs. 9 (6%) in the placebo group (2.53, 1.22 to 5.25).
• 9 patients in the probiotics group developed bowel ischaemia (8 with fatal outcome), vs none in the placebo group (p = 0.004).

The researchers conclude from these findings that prophylaxis with this combination of probiotic strains should not be administered in this category of patients as it did not reduce the risk of infectious complications and was associated with an increased risk of mortality.
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