Some Doctors Warming Up to Probiotics

Probiotics May Help Prevent Diarrhea in Patients on Antibiotics

Nov. 4, 2011 (Washington, D.C.) -- May I have a probiotic with that antibiotic please?

That's a question that hospitalized patients being started on antibiotics may want to ask their doctors, according to a panel of doctors convened by the American College of Gastroenterology at its annual meeting here.

A review of 22 studies involving 3,096 patients presented at the meeting showed that taking probiotics while on antibiotics may cut the risk of developing antibiotic-associated diarrhea by about 60%.

Patients took any of a variety of probiotics, most commonly S. boulardii, for an average of one-and-one-half weeks. Most were hospitalized during treatment.

A second analysis that pooled the results of 28 studies involving 3,338 patients showed those given probiotics for at least as long as they were on antibiotics were 56% less likely to develop antibiotic-associated diarrhea than those given placebo.

Why? For all the good they can do, antibiotics kill "good" bacteria along with the bacteria that cause illness. A decrease in beneficial bacteria may lead to digestive problems. Taking probiotics may help replace the lost beneficial bacteria and help prevent diarrhea.

Probiotics also appeared to provide protection against potentially deadly bouts of diarrhea caused by the bug Clostridium difficile, or C. diff., says researcher Rabin Rahmani, MD, a gastroenterologist at Maimonides Medical Center in New York City.

"By giving probiotics, you reduce the risk of antibiotic-associated diarrhea that occurs in 40% to 75% of hospitalized patients on antibiotics," says Fergus Shanahan, MD, of the Alimentary Pharmabiotic Centre, an industry-funded research center at the National University of Ireland at Cork.

In many cases, the diarrhea is mild and short lived; in others, it is severe and persistent, he says.

"We could debate whether all hospitalized patients on antibiotics need probiotics, but certainly the elderly, who are at high risk," Shanahan tells WebMD.

Brian E. Lacy, MD, PhD, a gastroenterologist at Dartmouth-Hitchcock Medical Center and moderator of the panel, went even further. "In my experience, it is certainly rational to offer probiotics [to hospitalized patients given antibiotics]," he says.

"There's no downside, in our experience," Lacy says.

Still, a better solution would be to be more selective in prescribing antibiotics to begin with, says panel member and probiotic researcher Eamonn M.M. Quigley, MD, professor of medicine at the National University of Ireland at Cork. He is co-founder of Alimentary Health Ltd., a biotechnology company that develops probiotic treatments.

The normal human digestive tract contains about 400 types of beneficial bacteria. Probiotic bacteria can be found in yogurt with live cultures and fermented milk and are available as dietary supplements.

Further study is needed to determine what type and dose of probiotic bacteria best prevent diarrhea, Quigley says.

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Baby Tips From Moms and Doctors

By Leslie Petrovski
WebMD Feature

Parents, especially new parents, hate seeing their babies suffer. Plus with all the warnings about over-the-counter medications and children under the age of 4, parents of infants are often confused. What’s safe? What’s effective? How can you ease common symptoms in your baby and maintain peace of mind?

Helping babies feel better is as much an art as it is a science. Who better to ask for advice than moms like you and seasoned docs?

Tips on Hiring Nannies

Unfortunately, it's not likely Mary Poppins, Supernanny Jo Frost, or even Nanny McPhee is going to show up at your door the morning you're ready to return to work from maternity leave. The search for a nanny can be daunting and the thought of leaving your newborn or toddler with a virtual stranger can be overwhelming, but it doesn't have to be. WebMD now makes hiring a nanny easier with tried-and-true tips from those in-the-know. While many reputable agencies are willing to do the work for...

Read the Tips on Hiring Nannies article > >

Congestion tends to be more challenging to deal with in babies than it is in adults. Why? Because babies can’t blow their noses.

To tackle stuffy noses and coughs, moms often recommend propping up the bed along with variations on the theme of water -- think steam and saline. One mom swears by her cool mist humidifier, while others recommend saline spray and a nasal bulb to loosen and suction away mucus.

Miriam Schechter, MD, an attending pediatrician at the Children’s Hospital at Montefiore Medical Center in Bronx, New York, is also a fan of the saline-and-nasal-aspirator approach for relieving nasal congestion.

She also suggests that parents invest in a humidifier. “This is something parents will get a lot of use out of,” she says. “There’s no magic cure for a cold, but putting moisture in the air can loosen mucus and help it drain out a little better.” A vaporizer can also soothe a sore throat.

When buying a humidifier, she says, choose a simple, inexpensive model. “When patients ask whether to buy cool mist or warm, I recommend cool mist for safety,” she says. “The warm mists have a heating element; you don’t want a child to stick his hand in front of that hot steam or to knock it over. But a cool mist humidifier is something parents will find very useful.”

Often the transition to eating solid food changes a baby’s elimination patterns. If your baby is having a hard time having bowel movements, try an ounce of good old-fashioned prune or apple juice.

Moms tend to worry if their babies skip a day, says Schechter. “It doesn’t bother us unless the stool is pebbly or dry.”

Schechter addresses constipation first with education, by explaining to parents what’s normal. As long as baby’s stools are soft and don’t cause discomfort when being passed, the child is probably not constipated, even if the baby goes only once a week.

But if your baby’s bowel movements are hard and dry, she suggests mixing up baby’s diet by cutting back on bananas and adding more fruit juice or baby prunes. “We wouldn’t use medication as a first-line treatment,” she says.

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Doctors Inc.: New for Aspiring Doctors, the People Skills Test

At Virginia Tech Carilion, the nation’s newest medical school, administrators decided against relying solely on grades, test scores and hourlong interviews to determine who got in. Instead, the school invited candidates to the admissions equivalent of speed-dating: nine brief interviews that forced candidates to show they had the social skills to navigate a health care system in which good communication has become critical.

The new process has enormous consequences not only for the lives of the applicants but, its backers hope, also for the entire health care system. It is called the multiple mini interview, or M.M.I., and its use is spreading. At least eight medical schools in the United States — including those at Stanford, the University of California, Los Angeles, and the University of Cincinnati — and 13 in Canada are using it.

At Virginia Tech Carilion, 26 candidates showed up on a Saturday in March and stood with their backs to the doors of 26 small rooms. When a bell sounded, the applicants spun around and read a sheet of paper taped to the door that described an ethical conundrum. Two minutes later, the bell sounded again and the applicants charged into the small rooms and found an interviewer waiting. A chorus of cheerful greetings rang out, and the doors shut. The candidates had eight minutes to discuss that room’s situation. Then they moved to the next room, the next surprise conundrum and the next interviewer, who scored each applicant with a number and sometimes a brief note.

The school asked that the actual questions be kept secret, but some sample questions include whether giving patients unproven alternative remedies is ethical, whether pediatricians should support parents who want to circumcise their baby boys and whether insurance co-pays for medical visits are appropriate.

Virginia Tech Carilion administrators said they created questions that assessed how well candidates think on their feet and how willing they are to work in teams. The most important part of the interviews are often not candidates’ initial responses — there are no right or wrong answers — but how well they respond when someone disagrees with them, something that happens when working in teams.

Candidates who jump to improper conclusions, fail to listen or are overly opinionated fare poorly because such behavior undermines teams. Those who respond appropriately to the emotional tenor of the interviewer or ask for more information do well in the new admissions process because such tendencies are helpful not only with colleagues but also with patients.

“We are trying to weed out the students who look great on paper but haven’t developed the people or communication skills we think are important,” said Dr. Stephen Workman, associate dean for admissions and administration at Virginia Tech Carilion.

Dr. Charles Prober, senior associate dean at the Stanford University School of Medicine, said Stanford always valued social skills in students — particularly the ability to work collaboratively with colleagues and establish trust with patients — but did not have a reliable way of ferreting these skills out until adopting mini interviews.

The system grew out of research that found that interviewers rarely change their scores after the first five minutes, that using multiple interviewers removes random bias and that situational interviews rather than personal ones are more likely to reveal character flaws, said Dr. Harold Reiter, a professor at McMaster University in Hamilton, Ontario, who developed the system.

In fact, candidate scores on multiple mini interviews have proved highly predictive of scores on medical licensing exams three to five years later that test doctors’ decision-making, patient interactions and cultural competency, Dr. Reiter said.

A pleasant bedside manner and an attentive ear have always been desirable traits in doctors, of course, but two trends have led school administrators to make the hunt for these qualities a priority. The first is a growing catalog of studies that pin the blame for an appalling share of preventable deaths on poor communication among doctors, patients and nurses that often results because some doctors, while technically competent, are socially inept.

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