Probiotics and care home residents

New research led by Trinity Professorial Fellow Christopher Butler has found that a daily dose of probiotics does not reduce the need for antibiotics to treat acute infections in care home residents.

Published in the Journal of the American Medical Association (JAMA), the clinical trial was looking at ways to prevent infections in care home residents – an area which has taken on increased urgency during the COVID19 pandemic.

Probiotics, which are live organisms, have long been promoted as health supplements. Many people, including frail elderly, take probiotics to stimulate their immune system and prevent infections. Research suggests that daily use of probiotics in children can reduce both the need for antibiotics to treat infections and the duration of respiratory illness, and in the US, the market for probiotics in hospital and nursing homes was estimated at £92.4 million, despite a lack of evidence of any beneficial effect in this population.

Led by Professor Butler in Oxford University’s Nuffield Department of Primary Care Health Sciences, with colleagues from the Universities of Cardiff and Southampton, the (PRINCESS) randomised controlled trial involved 310 residents aged over 65 from 23 UK care homes.. Residents were given either a daily capsule of two probiotics – Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp. Lactis BB-12, or a placebo, and compared the two groups for up to f a year.

The study, which was conducted before the coronavirus pandemic, shows no overall significant difference in antibiotic use in both groups, with the probiotic group requiring antibiotics to treat infectious diseases for 12.9 days on average, compared with 12 days for the placebo group.

Professor Butler said: ‘Antibiotics can be life-saving, but need to be prescribed only when necessary. Care home residents are prescribed more antibiotics than other sectors of the population, exposing them to risks of side-effects and anti-microbial resistance. Acute infections are particularly common because frailer, older people often have a weakened immune systems, and care homes residents live in close proximity so infections can spread more easily.’

‘Probiotics are frequently used by older residents in care homes or nursing homes to ward off infections, although the evidence on whether they can prevent infections and reduce antibiotic use in these settings is limited. Despite there being a possible beneficial effect in children and adults, our trial found no evidence for a similar benefit in care home residents.’

The researchers caution that these findings are not generalisable to other probiotics or probiotic combinations and may not apply to older people living outside of UK care homes.

The trial was managed by the Primary Care Clinical Trials Unit in the Nuffield Department of Primary Care Health Sciences and the Cardiff Centre for Trials Research.

Posted: 14 July 2020

Read more

Further news