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Clinical Infection & Immunity

Letter to the Editor

Volume 4, Number 1, March 2019, pages 19-20

Treating Clostridium difficile Infections With Oral Lactobacillus Bulgaricus B-30892: A Physician’s Experience

Numerous probiotics have been clinically tested [1-3] as a treatment for the prevention or elimination of Clostridium difficile (C. difficile) infections. Reviewed data [2, 3] suggest that of the different probiotic agents, Lactobacillus appears to be more effective. As one would expect, the efficacy of different subspecies and strains has proven to be variable. I have been an internist for the last 30 years. During this time I have treated numerous patients with various gastrointestinal diseases. I have found that oral treatment with Lactobacillus delbrueckii bulgaricus NRRL B-30892 to be effective against already established C. difficile and other gut infections resistant to antibiotic treatment. Listed below are 10 cases (nine successes and one failure) describing the use of Lactobacillus delbrueckii bulgaricus NRRL B-30892. The treatment consists of twice daily oral consumption of a milk-based media containing 5 × 10¹⁰ colony forming unit (CFU).

Patient 1 is a 40-year-old white female with a 3-week history of watery diarrhea after she was released from the hospital following resection of a schwannoma from the base of her skull. She couldn’t remember whether an antibiotic was given, but she tried Immodium and Lactobacillus acidophilus without improvement. Antibiotic-associated diarrhea was confirmed by stool analysis and she was treated with metronidazole, 500 mg orally three times daily for 10 days. She initially improved, but relapsed after she was given cefuroxime by another physician. C. difficile was confirmed with a stool analysis and she was given a second course of metronidazole, 500 mg orally three times a day for 10 days, but this time she did not improve. She then was given Lactobacillus bulgaricus B-30892 orally twice a day for 10 days, and had complete resolution of her symptoms. There have been no relapses in over a year.

Patient 2 is a 64-year-old white female with a 10-day history of watery diarrhea, cramping, and flatus. She had been hospitalized 5 weeks earlier for correction of a hallux valgus deformity. She could not remember whether an antibiotic was given. A stool for C. difficile toxin assay was positive and she was prescribed metronidazole, 500 mg orally three times daily for 10 days, but did not improve. She was then given Lactobacillus delbrueckii bulgaricus B-30892 orally twice daily for 10 days. She did improve initially, but diarrhea recurred after she was given Levaquin, 500 mg orally once daily for a urinary tract infection. Lactobacillus delbrueckii bulgaricus B-30892 was re-prescribed for an additional 20 days and she did improve but some diarrhea persisted. Repeat C. difficile toxin assay, stool for ova and parasites, Giardia antigen, enteric pathogens were all negative. She was suspected of having a flare of her irritable bowel syndrome and did improve with Fibercon and Levsinex.

Patient 3 is a 76-year-old white female with a 4-week history of loose stools and hematochezia. She had a history of bleeding hemorrhoids and was on Plavix for transient ischemic attacks. In reviewing her records, there was neither recent hospitalization nor any recent antibiotic use. A stool for ova and parasites, enteric pathogens, and Giardia antigen were all negative, but her C. difficile toxin assay was positive. She was given metronidazole 500 mg orally three times daily for 10 days, improved only slightly and was then given an additional 7-day course. Lactobacillus delbrueckii bulgaricus B-30892 was administered for 10 days, twice daily. Upon completion of the probiotic regimen, a complete resolution of the symptoms was observed in the patient, with no relapses in over 1 year.

Patient 4 is an 84-year-old white male who was hospitalized with bloody diarrhea. Workup included a colonoscopy, which showed extensive diverticular disease and a single tubular adenoma. His bleeding stopped, so he was released, but presented to my office with persistent diarrhea. A stool for ova and parasite and enteric pathogens were negative, but his C. difficile toxin assay was positive. He was given Lactobacillus delbrueckii bulgaricus B-30892 orally twice daily for 10 days, and had complete resolution of his diarrhea. He has not had a relapse in over 12 months.

Patient 5 is a 36-year-old white female with a 4-week history of abdominal pain and diarrhea. This developed after she was given Floxin for a urinary tract infection and Cleocin vaginal cream for bacterial vaginosis. A stool specimen for C. difficile toxin assay was positive and she was prescribed metronidazole, 500 mg orally three times daily for 10 days and was then given vancomycin at 125 mg for 14 days, with no success. She got better but re-presented 4 months later with a 2-week history of abdominal pain, diarrhea, and low grade fever. No new antibiotics were given. A stool specimen for ova and parasites, Giardia antigen, and enteric pathogens were all negative, but her C. difficile toxin assay was positive. She was given another 10 day course of metronidazole, but did not improve. This procedure was followed by vancomycin, 125 mg orally four times daily for 14 days. She failed with this treatment as well. Finally, she was given Lactobacillus delbrueckii bulgaricus B-30892, twice daily for 10 days, and had complete resolution of her symptoms. She has not had a relapse in over 15 months.

Patient 6 is 79-year-old white male with a 3-week history of abdominal pain, diarrhea, fecal urgency and incontinence. One month earlier he was treated with Omnicef for bronchitis. At the same time, he was visiting his mother in the hospital and she had C. difficile. A stool for ova and parasites, Giardia antigen, and enteric pathogens were all negative, but his stool for C. difficile toxin assay was positive. He was given Lactobacillus delbrueckii bulgaricus B-30892 orally twice daily for 10 days, and completely resolved his symptoms. No Flagyl or vancomycin was ever needed. He had no relapses in over 2 years.

Patient 7 is a 53-year-old white female with a 3-week history of diarrhea, fecal urgency, fecal incontinence, abdominal cramping, and mild hematochezia. This started shortly after taking clindamycin her dentist gave her for a dental infection. A stool for ova and parasites, Giardia antigen, and enteric pathogens were all negative, but her stool for C. difficile toxin assay was positive. She was given two rounds of Flagyl 500 mg orally three times daily for 10 days, along with over the counter yogurt she bought at the grocery store. She was having recurrent symptoms and was given two rounds of Lactobacillus delbrueckii bulgaricus B-30892 twice daily for 10 days each and completely resolved her symptoms. She has not had any recurrences in over two years.

Patient 8 is 55-year-old white male with a 10-day history of diarrhea after a 10-day course of Augmentin, 875 mg twice daily for 10 days, given to him for a Sinusitis. His stool for ova and parasites, Giardia antigen, enteric pathogens, and C. difficile toxin assay was negative. He was diagnosed with antibiotic-associated diarrhea. Lactobacillus delbrueckii bulgaricus B-30892 was given twice daily for 10 days and he completely resolved his symptoms, with no recurrence in over 2 years. Interestingly, he had something similar to this situation 2 years earlier and responded to Flagyl at that time.

Patient 9 is a 63-year-old white male, with a squamous cell cancer of his left tonsil and right tongue, was hospitalized after 6 days for aspiration pneumonia. He was treated with intravenous Zosyn in the hospital and released with an 8-day course of clindamycin. He developed watery diarrhea that did not respond to an unknown dose of Flagyl given to him by his oncologist. His stool for ova and parasites, Giardia antigen, enteric pathogens, and C. difficile toxin assay was negative. He was diagnosed with an antibiotic-associated diarrhea and was treated with Lactobacillus delbrueckii bulgaricus B-30892 twice daily for 10 days and he completely resolved his symptoms, with no recurrence in over 2 years.

Patient 10 is an 80-year-old white female with end-stage oxygen dependent chronic obstructive pulmonary disease (COPD), osteoporosis, and chronic renal failure, who developed C. difficile-associated diarrhea after taking Levaquin for a respiratory infection. She was given Lactobacillus delbrueckii bulgaricus B-30892 daily for 10 days, but did not improve. She was subsequently given metronidazole, 500 mg daily three times daily for 10 days, but did not improve with it either. She eventually did improve, though, with vancomycin, 125 mg daily four times a day for 14 days, but relapsed shortly after cessation. She was then placed back on vancomycin with a slow taper over 16 weeks, got better, but then relapsed again and she was placed back on another 16-week course of vancomycin. One month after finishing vancomycin, she unfortunately died of end stage renal disease.

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