The human intestinal microflora

Intestinal distribution and intraluminal localization of orally administered Clostridium butyricum in rats

Clostridium butyricum has been used as a probiotic in animals and humans for years, however, its fate in the intestine has not been clarified yet. We investigated the intestinal fate of C. butyricum using a selective medium and a monoclonal antibody after orally administering C. butyricum spores to rats. The number of C. butyricum, both viable and dead cells, in the intestinal contents were counted by enzyme-linked immunosorbent assay (ELISA) at various times after a single oral administration. The total viable number of C. butyricum was counted using a selective medium, and viable resting spores were selectively detected by treating the samples with ethanol. To investigate the intraluminal localization of the C. butyricum cells, frozen intestinal tracts were imprinted onto slides and stained with immunogold-silver. Total viable spores exceeded the number of viable resting spores by more than 10-fold from the proximal to middle of the small intestine 30 min after administration. Vegetative cells of C. butyricum were first detected in the distal small intestine after 2 hr, and vegetative growth was observed from the cecum to the colon 5 hr after administration. Dead vegetative cells were detected 9 hr after administration, and C. butyricum cells were not detected in the intestine after 3 days. The C. butyricum cells in the intestinal imprints were stained specifically by immunogold-silver staining, and proliferative cells were observed in the cecum after 3 hr. These results suggest that the administered C. butyricum germinated in the upper small intestine, grew mainly from the distal small intestine to the colon and were excreted from the rat intestine within 3 days.

Tropical sprue and subclinical enteropathy: a vision for the nineties

Aside from infectious intestinal diseases with known etiology, there is a group of gastrointestinal disorders mainly affecting the small intestine of individuals predominantly living in and less often visiting or returning from the Third World, usually the tropics, and ranging from asymptomatic structural and/or functional abnormalities of the gastrointestinal mucosa (subclinical enteropathy, SE) to a fully symptomatic condition highlighted by malabsorption of nutrients with associated nutritional deficiencies responsive to folate and broad spectrum antibiotic treatment (tropical sprue, TS). Mounting evidence supports an infectious cause in many instances. The exact nature of the infection, whether initiated and/or perpetuated by enterotoxigenic coliform bacteria, virus(es) or a combination of these, is not clear. Further studies, including those using molecular techniques, are needed in order to clarify various aspects of these widely prevalent disorders.

Luminal bacteria and small-intestinal permeability

BACKGROUND

The influence of luminal bacteria on small-intestinal permeability has not been fully assessed. This study addressed this issue.

METHODS

Thirty-four subjects (mean age 64 years; range 22-95 years) were investigated for possible small-intestinal bacterial overgrowth (SIBO) with culture of a small-intestinal aspirate. A lactulose/mannitol small-intestinal permeability test was performed, small-intestinal histology assessed and serum vitamin B12 concentrations measured in all subjects. Permeability was also assessed in a control group of 34 asymptomatic volunteers.

RESULTS

Urinary lactulose/mannitol ratios were significantly increased in subjects with SIBO with colonic-type flora (P < 0.0005), even in the absence of villous atrophy. Urinary lactulose/mannitol ratios were increased in this group due to significantly increased urinary lactulose concentrations (P < 0.0005) rather than reduced urinary mannitol levels, after correcting for inter-subject variations in renal function. Counts of intraepithelial lymphocytes of CD8 phenotype were significantly increased in this group (P = 0.003). Although a significant correlation was found between intraepithelial lymphocyte counts and small-intestinal permeability overall (P < 0.002), these counts were not significantly different in subjects with SIBO with colonic-type flora whose permeability values were < or = > 0.028, the upper limit of normal in asymptomatic controls. Serum vitamin B12 concentrations did not differ significantly between groups (P > 0.5). Ageing did not independently influence small-intestinal permeability (P > 0.5).

CONCLUSIONS

Small-intestinal permeability is increased in subjects with SIBO with colonic-type bacteria. This effect is independent of ageing and not mediated by vitamin B12 deficiency. Although counts of intraepithelial lymphocytes of CD8 phenotype are increased in this disorder, it is also unlikely that these cells play an important causative role in this process. Routine light microscopic assessment underestimates the prevalence of small-intestinal functional disturbance in this disorder.

Infectious Diarrhea

Infectious diarrhea constitutes a major source of morbidity and mortality for all age groups. The focus of this article is to identify high risk host and pathogenic risk determinants of enteric infections, discuss pathophysiologic mechanisms for diarrhea, review conventional and upcoming therapeutic managements of bacterial, protozoal or viral-type diarrhea, and describe the integral role of the pharmacist in the overall care of patients having this illness.

The expression of complement protein 4 and IgG3 in luminal secretions

BACKGROUND

Factors regulating proximal small-intestinal luminal concentrations of IgG3, the predominant IgG subclass at this site, are unclear. This study determined whether luminal IgG3 concentrations are related to those of complement protein 4 (C4), an acute-phase reactant predominantly derived from local mucosa.

METHODS

Proximal small-intestinal luminal and peripheral blood IgG subclass and C4 concentrations were measured by radial immunodiffusion in 30 adult subjects without predisposition to disturbed mucosal immunity. Mucosal C4 immunoreactivity and the presence or absence of small-intestinal bacterial overgrowth were determined in all subjects. Caecal luminal concentrations of IgG3 and C4 were measured in a separate cohort of eight asymptomatic subjects.

RESULTS

Proximal small-intestinal luminal C4 and IgG subclass concentrations were not significantly influenced by the presence of absence of small-intestinal bacterial overgrowth (P > 0.2). Nor did plasma C4 levels significantly influence C4 concentrations in small-intestinal luminal secretions (P > 0.2). Mucosal immunoreactivity for C4 was present in every subject. A significant correlation was found between C4 and IgG3 concentrations in proximal small-intestinal luminal secretions (P < 0.0005) and also in caecal secretions (P < 0.05) but not in peripheral blood (P > 0.1).

CONCLUSIONS

Common factors, not including the presence or absence of small-intestinal bacterial overgrowth, regulate luminal concentrations of C4 and IgG3. Local investigation is mandatory when assessing mucosal immune mechanisms.

Luminal immunity in small-intestinal bacterial overgrowth and old age

BACKGROUND

The independent influences of small-intestinal bacterial overgrowth and old age on mucosal immunoglobulin production and secretion have not been assessed. This is an important issue, since luminal IgA deficiency may exacerbate small-intestinal bacterial overgrowth, the prevalence of which is high in selected elderly populations.

METHODS

Proximal small-intestinal aspirates were obtained from 33 subjects for bacteriologic analysis and measurement of total IgA, IgM, total IgG. IgG subclass, and IgD concentrations. IgA subclasses were measured in 24 unselected subjects. Serum immunoglobulin and salivary IgA concentrations were measured in all subjects.

RESULTS

IgA2 and IgG3 were predominant IgA and IgG subclasses in proximal small-intestinal luminal secretions. Luminal concentrations of IgA2 and IgM, but not IgG3 or any other IgG subclass, were significantly increased in small-intestinal bacterial overgrowth, which was present in 19 of 33 (57.6%) subjects. Old age did not influence these levels. Luminal immunoglobulin concentrations did not correlate significantly with either serum or salivary values. IgD was not measureable in proximal small-intestinal secretions.

CONCLUSIONS

Increased luminal concentrations of the secretory immunoglobulins, IgA2 and IgM, occur in small-intestinal bacterial overgrowth. Local investigation is mandatory when assessing the mucosal immunopathology of this disorder. Luminal IgG3 is unlikely to be predominantly derived from serum. Old age does not independently influence luminal immunity.

Mucosal cytokine production in small-intestinal bacterial overgrowth

BACKGROUND

Mucosal production of interferon-gamma, interleukin-6, and tumour necrosis factor-alpha is increased in inflammatory bowel disease and parallels disease activity. Interferon-gamma production is also increased in coeliac disease. Conversely, local cytokine profiles have not been investigated in small-intestinal bacterial overgrowth. This study addressed this issue.

METHODS

Eighteen adult subjects were studies with culture of proximal small-intestinal luminal secretion and measurement of luminal interferon-gamma, interleukin-6, and tumour necrosis factor-alpha concentrations by enzyme-linked immunosorbent assay. Small-intestinal histology was assessed by light microscopy.

RESULTS

Interferon-gamma, interleukin-6, and tumour necrosis factor-alpha were measurable in proximal small-intestinal luminal secretions of all subjects, even in the absence of light microscopic evidence of enteropathy. Small-intestinal bacterial overgrowth was present in 12 of 18 (66.7%) subjects. Luminal concentrations of neither interferon-gamma nor tumour necrosis factor-alpha differed significantly in subjects with and without small-intestinal bacterial overgrowth (P + 0.06 and P = 1.0, respectively). Conversely, luminal interleukin-6 concentrations were significantly increased in subjects with this disorder (P = 0.02). Multivariate linear regression analysis suggested that colonic-type rather than salivary-type flora mediated this increased interleukin-6 response (P = 0.02 and P = 0.64, respectively). No correlation was found between luminal interleukin-6 and tumour necrosis factor-alpha concentrations, even after the confounding influence of colonic-type bacteria was excluded (P = 0.60).

CONCLUSIONS

These findings suggest that increased mucosal production of interleukin-6 occurs in small-intestinal bacterial overgrowth, particularly when the overgrowth flora includes colonic-type bacteria. Conversely, luminal levels of neither interferon-gamma nor tumour necrosis factor-alpha are increased in the circumstance, distinguishing the local cytokine profile in this disorder from those that occur in coeliac disease and inflammatory bowel disease.

Efficacy of SF 68 in the treatment of acute diarrhea. A placebo-controlled trial

BACKGROUND

The therapeutic value of Bioflorin, a preparation containing Enterococcus SF 68 strain, was evaluated in adult patients with acute diarrhea.

METHODS

In a double-blind randomized trial we compared the effect of SF 68 strain in a dose of 150 x 10(6) colony-forming units three times a day for 5 days compared with placebo on the duration of diarrhea in 211 adults.

RESULTS

Patients receiving SF 68 had a reduced duration of diarrhea compared with placebo, with a highly statistically significant difference between treatments. The proportion of patients with continuing diarrhea during the 2nd day of treatment was 61% in patients receiving SF 68 and 96% in those receiving placebo (P < 0.01). During the 3rd day diarrhea was still present in 8% of patients given SF 68, compared with 66% of those given placebo (P < 0.01). The mean (+/-SD) duration of diarrhea was 1.69 days (0.6) in patients given SF 68 compared with 2.81 days (0.9) in those given placebo. When pathogens were found in the first stool culture, they could not be detected at post-treatment examination. No adverse reactions were observed.

CONCLUSIONS

Oral bacteriotherapy with SF 68 strain shortens the duration and the severity of diarrhea in adults and represents a safe and effective approach to re-establishing a balanced microbial flora in this condition.

Breath hydrogen excretion by healthy cats after oral administration of oxytetracycline and metronidazole

Breath hydrogen excretion over a period of three hours was measured to evaluate carbohydrate malassimilation in healthy cats treated orally with antibiotics. Both an absorbable carbohydrate (xylose) and a non-absorbable carbohydrate (lactulose) were administered during the tests to evaluate the changes in the intestinal mucosa and the population of bacteria within the intestinal lumen. Overall, the effects of oxytetracycline and metronidazole on breath hydrogen excretion were not significantly different. However, the treatment effect with an antibiotic did significantly change breath hydrogen excretion after xylose administration (P < 0.05) within groups. Similarly, with each antibiotic, breath hydrogen excretion was affected significantly (P < 0.001) by the time after the administration of the carbohydrate. Treatment with each antibiotic also interacted significantly with this time effect (P < 0.05) within groups. After lactulose administration, there was a trend within groups for the type of antibiotic to interact with the treatment effect on breath hydrogen excretion (P = 0.09). After oxytetracycline treatment, more hydrogen was exhaled during the first 120 minutes after lactulose administration than in the pre-antibiotic test, whereas after metronidazole treatment, less hydrogen was exhaled between 60 and 180 minutes after lactulose, administration. After treatment with either oxytetracycline or metronidazole, more hydrogen was exhaled after xylose administration. Obligate anaerobes could be isolated from samples of small intestinal fluid obtained endoscopically after oxytetracycline treatment, but they could not be isolated after treatment with metronidazole.

Piperacillin/tazobactam in the treatment of polymicrobial infections

Polymicrobial infections are characterized by the presence of micro-organisms from more than one group of bacteria. Empirical treatment of polymicrobial infections requires an agent active against both anaerobic and aerobic/facultative bacteria. An aminoglycoside used in combination with an anti-anaerobe agent is commonly used to treat polymicrobial infections. However, aminoglycoside nephrotoxicity and treatment failures raise questions about the use of such regimens. Among non-aminoglycoside treatment regimens such as penicillin and cephalosporins, effectiveness has been compromised by bacteria producing extended spectrum beta-lactamases. Cefoxitin shows satisfactory results for treatment of intra-abdominal infections. Other studies have shown good results with imipenem, cefotetan and piperacillin used as single agents. Piperacillin/tazobactam, a new combination broad-spectrum antibiotic and potent beta-lactamase inhibitor, can be used for the treatment of infections caused by piperacillin-sensitive micro-organisms as well as beta-lactamase-producing, piperacillin-resistant organisms. This broad-spectrum activity is appropriate for infections traditionally treated empirically by double or triple antibiotic therapy.

Microflora of abdominal sepsis by locus of infection

Specimens from 152 abdominal infections were examined to determine which groups of endogenous bacteria participate in infection emanating from different sites in the gastrointestinal tract. A notable finding was the predominance of anaerobic microflora from infections of ischemic versus perforated small bowel. Empiric antibiotic treatment for ischemic bowel should include focused coverage for anaerobes.

Adhesion of human bifidobacterial strains to cultured human intestinal epithelial cells and inhibition of enteropathogen-cell interactions

Thirteen human bifidobacterial strains were tested for their abilities to adhere to human enterocyte-like Caco-2 cells in culture. The adhering strains were also tested for binding to the mucus produced by the human mucus-secreting HT29-MTX cell line in culture. A high level of calcium-independent adherence was observed for Bifidobacterium breve 4, for Bifidobacterium infantis 1, and for three fresh human isolates from adults. As observed by scanning electron microscopy, adhesion occurs to the apical brush border of the enterocytic Caco-2 cells and to the mucus secreted by the HT29-MTX mucus-secreting cells. The bacteria interacted with the well-defined apical microvilli of Caco-2 cells without cell damage. The adhesion to Caco-2 cells of bifidobacteria did not require calcium and was mediated by a proteinaceous adhesion-promoting factor which was present both in the bacterial whole cells and in the spent supernatant of bifidobacterium culture. This adhesion-promoting factor appeared species specific, as are the adhesion-promoting factors of lactobacilli. We investigated the inhibitory effect of adhering human bifidobacterial strains against intestinal cell monolayer colonization by a variety of diarrheagenic bacteria. B. breve 4, B. infantis 1, and fresh human isolates were shown to inhibit cell association of enterotoxigenic, enteropathogenic, diffusely adhering Escherichia coli and Salmonella typhimurium strains to enterocytic Caco-2 cells in a concentration-dependent manner. Moreover, B. breve 4 and B. infantis 1 strains inhibited, dose dependently, Caco-2 cell invasion by enteropathogenic E. coli, Yersinia pseudotuberculosis, and S. typhimurium strains.

Prevalence and consistency of low breath H2 excretion following lactulose ingestion. Possible implications for the clinical use of the H2 breath test

The clinical use of the H2 breath test is limited by the finding that a variable fraction of the population fails to excrete appreciable H2 during colonic carbohydrate fermentation. Therefore, we assessed the ability to increase breath H2 excretion in 371 patients (224 female, 147 male) by administering the nonabsorbable sugar lactulose. Following 12g of lactulose, 27% of 94 patients did not increase their breath H2 concentration over 20 ppm and were considered low H2 excretors. Ingestion of 20 g of lactulose in 277 patients yielded a frequency of low H2 excretors of 14%. Six of 10 patients that were low H2 excretors after 12g of lactulose increased their breath H2 levels over 20 ppm when tested with 20g. In 35 patients tested with the same amount of lactulose on two separate occasions, the subject frequently altered his or her H2 producing status over a period of a few weeks. Low H2 excretors had a significantly higher breath CH4 concentration, both fasting (22 +/- 34 ppm) and after lactulose (51 +/- 58 ppm) compared to the remaining patients (5 +/- 13 ppm and 16 +/- 40 ppm, respectively). While the mean age of low excretors (54 +/- 17 years) was significantly higher than the others (44 +/- 17 years), no difference was found for sex prevalence and stool pH. This study demonstrates that respiratory H2 excretion following lactulose ingestion is not consistent and suggests that the application of too restrictive criteria could lead to improper interpretation of the H2 breath test.

Role of bile acids and metabolic activity of colonic bacteria in increased risk of colon cancer after cholecystectomy

Since the metabolic activity of the colonic flora plays a definite role in colon cancer and an increased incidence of this disease is reported after cholecystectomy, we studied the metabolic activity of the colonic flora in a group of postcholecystectomy patients and matched controls by measuring, as representative end products of the bacterial metabolism, their fecal bile acids (BA), fecal 3-methylindole (SK) and indole (IN), and respiratory methane and hydrogen. Patients had significantly higher SK and lower IN, and, among BA, higher lithocholic (LCA) and chenodeoxycholic acid concentrations and LCA/deoxycholic acid ratio in the stools than controls. Similar differences from controls were reported for colon cancer. Comparable bacterial metabolic activities are thus operative in the large bowel of postcholecystectomized and colon cancer patients. This supports the biological plausibility of the association of cholecystectomy and colon cancer.

Effects of PGE2, misoprostol, and enprostil on guinea pig enterocyte adenylate cyclase. Clinical implications

Prostaglandins of the E series (PGE) are known to stimulate intestinal water and electrolyte secretions via the activation of the enterocyte adenylate cyclase. Their methylated synthetic analogs misoprostol and enprostil induced diarrhea in 5-13% of the patients in most clinical studies. In order to elucidate the role of PGE-adenylate cyclase interaction in these phenomena, we studied the stimulation of adenylate cyclase by native prostaglandin E2 (PGE2) and synthetic PGE analogs on isolated guinea pig intestinal epithelial cells. PGE2 stimulation of adenylate cyclase was dose-dependent, reaching a maximum for 3 x 10(-4) M, with an EC50 of 3.7 x 10(-6) M. The Hill analysis of the concentration-response curve gave a straight line, with a slope close to 1. The effect of PGE2 was strictly additive to that of 10(-5) M forskolin, whereas it was decreased in terms of potency by 10(-9) M cholera toxin. Somatostatin-14 markedly inhibited PGE2 stimulation by 37% and 45% with 10(-9) M and 10(-6) M, respectively. The two PGE methylated analogs misoprostol and enprostil were less potent than PGE2 in stimulating adenylate cyclase in our model.(ABSTRACT TRUNCATED AT 250 WORDS)

The distribution of homologous enterococcal plasmid DNA sequences in human faecal isolates

Hybridization was used to investigate the distribution of enterococcal plasmid sequences among 306 strains of Enterococcus and Streptococcus spp. isolated from faeces of humans of various ages. As DNA probes for the survey three plasmids, whose DNAs did not hybridize each other and designated as pMS13, pTW34 and pHK30, were selected from plasmids borne in Ent. faecalis. pTW34 DNA hybridized only with DNAs from enterococci, with high frequency in Ent. faecalis and low frequency in Ent. faecium. pMS13 DNA hybridized with DNAs of all Enterococcus spp. tested and with Strep. bovis, Strep. equinus and Strep. salivarius. Eighty-five percent of Ent. faecium isolates had sequences homologous to pMS13 but in the other species the values were less than 60%. Some enterococci had DNAs which hybridized with the pHK30 probe. The different distribution of the three DNA sequences indicates the possibility that plasmid DNAs encode advantageous phenotypes for the colonization of bacteria in the lumen of the bowel.

Survival of Lactobacillus species (strain GG) in human gastrointestinal tract

A newly isolated strain of a species of Lactobacillus of human origin, designated GG (Lactobacillus GG), has been studied to determine its ability to survive in the human gastrointestinal tract. When fed to 76 volunteers as a frozen concentrate or as a fermented preparation in milk or whey, Lactobacillus GG was recovered in the feces of all subjects receiving the fermented milk or whey and in 86% receiving the frozen concentrate when a single fecal specimen was cultured. The organism was also present in the feces of subjects concurrently receiving ampicillin. After terminating feeding of the organism, Lactobacillus GG persisted in the feces of 87% of volunteers four days later and in 33% of subjects seven days later. Lactobacillus GG lowered fecal bacterial beta-glucuronidase activity by approximately 80% in volunteers given the organism for four weeks. These studies demonstrate that Lactobacillus GG can survive and temporarily colonize the human gastrointestinal tract and can affect the metabolic activity of the resident microflora.

Alterations of intestinal microflora by antibiotics. Effects on fecal excretion, transit time, and colonic motility in rats

The effects of intragastric antibiotics in rats were examined on fecal microflora and excretion and through transit time and cecocolonic myoelectric activity. A solution of nonabsorbable antibiotics infused into the stomach for 20 days had a dramatic effect on the quantity, composition, and bacterial content of rat feces. Both the dry weight and the water content of feces were increased. The amount of short-chain fatty acids in the feces was dramatically lowered. However, neither total nor cecocolonic transit time of solids was affected. The cyclic organization of cecocolonic myoelectric activity was altered by antibiotic treatment, and the motility index, ie, the quantity of myoelectric activity recorded on the colon, progressively increased. An infusion of short-chain fatty acids modified this motor pattern but did not restore activity to a level comparable to that of control animals. In conclusion, intragastric antibiotics dramatically reduced intestinal microflora and increased fecal excretion of dry matter and water but did not affect the transit time of solid gut contents, although they did influence cecocolonic motility.

Infectious Gastroenteritis

Infectious gastroenteritis currently constitutes the greatest source of morbidity and mortality among various age groups. Issues of focus for this article include establishing epidemiological determinants of risk for enteric infection, describing host factors that favor survival of the infecting enteric pathogen, defining pathophysiological mechanisms of diarrhea, and reviewing the therapeutic management of bacterial, protozoal, and viral infectious diarrhea.

Colon-specific delivery of dexamethasone from a glucoside prodrug in the guinea pig

Dexamethasone-beta-D-glucoside is a potential prodrug for colonic delivery of the antiinflammatory agent, dexamethasone. The ability of this prodrug to deliver dexamethasone selectively to the colon depends not only on its being slowly absorbed from the alimentary canal, but also on its having chemical and enzymatic stability in the stomach and small intestine. Once reaching the large bowel, it should be quantitatively hydrolyzed to release the active agent. The potential of dexamethasone-beta-D-glucoside for colon-specific delivery of dexamethasone is assessed by determining the rates of its hydrolysis down the alimentary canal of the guinea pig, an animal in which an inflammatory bowel disease model has been developed. The hydrolytic activity is examined in tissues and luminal contents of the stomach, proximal and distal segments of the small intestine, cecum, and colon. For the tissues, the greatest hydrolytic activity is in the proximal small intestine, while the stomach, cecum, and colon have only moderate activity. In contrast, the contents of the cecum and colon show greater activity than the contents of the small intestine and stomach. The luminal contents retained beta-glucosidase activity even after repeated centrifugation and resuspension in a buffer. The activity was unaffected by homogenization. These observations suggest that hydrolytic activity is associated with enzymes located on the surface of luminal cells. The movement and hydrolysis of dexamethasone-beta-D-glucoside down the gastrointestinal tract of the guinea pig are also examined. About 20 to 30% of an oral dose appears to reach the cecum. Here the prodrug is rapidly hydrolyzed to the active drug. From intravenous administration of the prodrug and drug, it is apparent that dexamethasone-beta-D-glucoside is poorly absorbed in the gastrointestinal tract (bioavailability, less than 1%). There is a ninefold selective advantage for delivery of dexamethasone in cecal tissues in the guinea pig under the conditions of this experiment. Thus, there is a potential for a decrease in the usual dose and a concomitant reduction in the systemic exposure to dexamethasone. Because humans have much less glucosidase activity in the small intestine, even greater site-selective delivery to the cecum and colon is expected.

Microorganisms and diarrhea in enterally fed intensive care unit patients

Thirty-six intensive care unit patients, receiving aseptic or manually (routine) reconstituted enteral feeding formulas, were evaluated prospectively for the relationship of microbial involvement, gastric pH, and antimicrobial therapy to diarrhea. The routine protocol group had a significantly higher incidence of bacterial contamination than the aseptic protocol group (Fisher's exact test, p less than 0.05). There were no significant direct associations between isolate category (Gram-negative bacilli, Gram-positive cocci, Gram-negative cocci, yeast), gastric pH, or antimicrobials and diarrhea. However, two organisms (Group D Enterococci and yeast) were indirectly implicated in some cases of diarrhea.

Double-blind report on the efficacy of lactic acid-producing Enterococcus SF68 in the prevention of antibiotic-associated diarrhoea and in the treatment of acute diarrhoea

A multicentre double-blind, placebo-controlled clinical trial, involving 123 patients at 10 centres, was carried out to assess the efficacy of a preparation of lactic acid-producing Enterococcus SF 68 in the prevention of antibiotic-associated diarrhoea and in the treatment of acute diarrhoea. In the prevention study, 45 patients being treated with antibiotics were given, concurrently, one capsule twice daily of either Enterococcus SF68 or placebo. Acute diarrhoea was present in 78 patients who were given the same treatment but three times daily. All treatments were continued for 7 days. Enterococcus SF 68 was shown to be effective in reducing the incidence of antibiotic-associated diarrhoea in comparison with placebo (8.7% compared with 27.2%, respectively). Patients with acute enteritis showed a significantly faster resolution of bowel abnormalities during treatment with Enterococcus SF68 compared with placebo.

Quality Assurance of Health Care: The Case of Hernia Mortality

The mortality rate attributed to hernias in 24 European countries in the last decades are analysed in the interest of quality assurance in health care. Ranking countries according to the mortality rate and to the distribution of deaths by age groups gives an acceptable and appropriate method for the assessment of both the health situation and the health services in different countries.