Lactobacillus gg
Place in Therapy
Place in Therapy
After a review of the best current evidence, lactobacillus GG (LGG) for the prophylaxis of traveler’s diarrhea should be avoided, and reserved as third-line. The rationale for this is based on the paucity of efficacy data for LGG; however, due to its side-effects profile being comparable to placebo, it is reasonable to accept its use as third-line if patients request it or cannot use either of the first or second-line agents. Although the only robustly designed trial that looked at LGG for traveler’s diarrhea prophylaxis did find a significant reduction in diarrhea incidence, it did not use a commercially available formulation of LGG and it also may have overestimated the effect-size through per-protocol analysis. Both the Pharmacists’/Prescribers’ Letter and UpToDate accept that LGG preparations may be useful, but that there is not enough data to recommend it routinely. (1,2) As such, we are willing to accept Culturelle for traveler’s diarrhea prophylaxis, but not recommend it.
References:
1. Wanke. CA, Calderwood SB, Bloom A. Travelers’ Diarrhea. Up to date. Accessed on March 10, 2014. http://www.uptodate.com/contents/travelers-diarrhea?source=machineLearning&search=travelers+diarrhea&selectedTitle=1~50§ionRank=1&anchor=H11#H11
2. Cupp M. Comparison of Common Probiotic Products. Pharmacist’s Letter/Prescriber’s Letter. Jul 2012. PL Detail Document #280707
After a review of the best current evidence, lactobacillus GG (LGG) for the prophylaxis of traveler’s diarrhea should be avoided, and reserved as third-line. The rationale for this is based on the paucity of efficacy data for LGG; however, due to its side-effects profile being comparable to placebo, it is reasonable to accept its use as third-line if patients request it or cannot use either of the first or second-line agents. Although the only robustly designed trial that looked at LGG for traveler’s diarrhea prophylaxis did find a significant reduction in diarrhea incidence, it did not use a commercially available formulation of LGG and it also may have overestimated the effect-size through per-protocol analysis. Both the Pharmacists’/Prescribers’ Letter and UpToDate accept that LGG preparations may be useful, but that there is not enough data to recommend it routinely. (1,2) As such, we are willing to accept Culturelle for traveler’s diarrhea prophylaxis, but not recommend it.
References:
1. Wanke. CA, Calderwood SB, Bloom A. Travelers’ Diarrhea. Up to date. Accessed on March 10, 2014. http://www.uptodate.com/contents/travelers-diarrhea?source=machineLearning&search=travelers+diarrhea&selectedTitle=1~50§ionRank=1&anchor=H11#H11
2. Cupp M. Comparison of Common Probiotic Products. Pharmacist’s Letter/Prescriber’s Letter. Jul 2012. PL Detail Document #280707