Drug News Probiotics may help prevent ventilator-associated pneumonia
By David Liu, Ph.D.
Nov 6, 2008 - 12:04:53 PM
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Thursday November 6, 2008 (foodconsumer.org) -- A new
study suggests that probiotics defined by WHO as
live microorganisms which when administered in adequate amounts confer
a health benefit on the host may be enlisted to fight pathogens that
cause respiratory illness in ventilated patients.
The study showed the probiotic bacterium, Lactobacillus
plantarum 299, prevented the most common cause of ventilator-associated
pneumonia (VAP) as effectively as an antiseptic called chlorhexidine (CHX).
The study was conducted by Bengt Klarin from the University
Hospital in Lund, Sweden and colleagues and published in BioMed Central's open
access journal Critical Care.
The randomized, controlled trial was meant to test
Klarin's hypothesis that "swabbing the mouth with probiotics would be an
effective (and microbiologically attractive) method of reducing pathogenic oral
microorganisms in intubated, mechanically ventilated, critically ill
patients."
VAP is a common complication affecting patients on
breathing machines. It occurs when pathogenic bacteria from the mouth, throat
or breathing tube are inhaled into the lungs.
The common preventative measure is use of chlorhexidine
(CHX) solution as mouthwash to eliminate harmful bacteria, but the drug causes
a number of side effects including irritation, tooth staining, and occasional
allergic reactions.
In the trial, fifty critically ill patients on mechanical
ventilation machines were randomly assigned either oral mechanical cleansing
followed by washing with 0.1% CHX solution or to the same cleansing procedure
followed by oral application of an emulsion of Lp299.
Samples were taken from the oropharynx and trachea at
inclusion and at defined intervals thereafter for microbiological examinations.
The researchers found that "potentially pathogenic
bacteria that were not present at inclusion were identified in oropharyngeal
samples from eight of the patients treated with Lp299 and 13 of those treated
with CHX (p = 0.13). Analysis of tracheal samples yielded similar results.
Lp299 was recovered from the oropharynx of all patients in the Lp299
group."
One drawback for the CHX solution is that it will be dilated
by saliva and can cause a number of side effects. In contrast, this probiotic
solution adheres to the oral mucosa and counteracts potentially pathogenic
bacteria 24 hours a day.
But the trial is small although the results showed
promise.
A large trial is needed to
confirm the findings before the probiotics can be used clinically to prevent the upper
respiratory infections in patients on ventilators or used as a common oral care
product for healthy people.
For the details of the study, read the full report.