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1 November 2006

Volume 43, Number 9
Clinical Infectious Diseases 2006;43:1170–1175
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4309-0008$15.00
DOI: 10.1086/508178
MAJOR ARTICLE

Absence of Efficacy Of Nonviable Lactobacillus acidophilus for the Prevention of Traveler's Diarrhea: A Randomized, Double‐Blind, Controlled Study

Valérie Briand,1

Pierre Buffet,2

Sabine Genty,3,5,6

Karine Lacombe,4

Nadine Godineau,7

Jérome Salomon,8

Eric Vandemelbrouck,9

Pascal Ralaimazava,5,6

Catherine Goujon,2

Sophie Matheron,3

Arnaud Fontanet,1 and

Olivier Bouchaud5,6

1Emerging Diseases Epidemiology Unit and 2Medical Center, Institut Pasteur, 3Department of Infectious and Tropical Diseases, Hôpital Bichat Claude Bernard, and 4Department of Infectious and Tropical Diseases, Hôpital St. Antoine, Paris, 5Department of Infectious and Tropical Diseases, Hôpital Avicenne–Université Paris 13, Bobigny, 6Institut de Médecine et d’Epidémiologie Appliquée–Fondation Internationale, Léon Mba, 7Parasitology Unit, Hôpital Delafontaine, Saint‐Denis, 8Department of Infectious and Tropical Diseases, Hôpital Raymond Poincarré, Garches, and 9Parasitology Unit, Hôpital De Gonesse, Gonesse, France

Background.Diarrhea is the most common illness associated with international tourism. We evaluated the efficacy of a probiotic preparation of nonviable Lactobacillus acidophilus (hereafter referred to as LA) for the prevention of traveler's diarrhea.

Methods.We conducted a randomized, double‐blind, controlled trial. Travelers were randomized to receive either LA or placebo twice daily from 1 day before their departure to 3 days after their return. On each day of the trip and the week following the return, travelers had to record the number and consistency of stools and their adherence to the treatment. Diarrhea was defined as 3 unformed stools in a 24‐h period.

Results.From January 2001 to September 2004, a total of 174 subjects were randomized to each treatment group. Half of the travelers went to West Africa, and organized tours or backpacking were the most common modes of traveling. The incidence of diarrhea did not differ between the 2 groups; it was 61.4 cases per 100 person‐months in the LA group (95% confidence interval [CI], 44.1–85.5) and 43.4 cases per 100 person‐months in the placebo group (95% CI, 30.0–62.9) ( ). Adjustment for travel duration and other variables did not reveal any difference between the 2 groups (adjusted hazard ratios comparing the LA and placebo groups were 1.43 [95% CI, 0.87–2.36] in an intent‐to‐treat analysis and 1.38 [95% CI, 0.79–2.39] in an efficacy analysis).

Conclusions.There was no beneficial effect of treatment with LA for the prevention of travelers' diarrhea. More studies are required to assess the efficacy of other specific probiotics (e.g., a Lactobacillus rhamnosus GG preparation) for preventing traveler's diarrhea.

Received 11 May 2006; accepted 10 July 2006; electronically published 27 September 2006.

Reprints or correspondence: Dr. Valérie Briand, Institut Pasteur, Emerging Diseases Epidemiology Unit, Bâtiment Laveran 3ième étage, 25, rue du Docteur Roux, 75015 Paris, France ().

Cited by

Herbert L. DuPont, Charles D. Ericsson, Michael J. G. Farthing, Sherwood Gorbach, Larry K. Pickering, Lars Rombo, Robert Steffen, Thomas Weinke. (2009) Expert Review of the Evidence Base for Prevention of Travelers’ Diarrhea. Journal of Travel Medicine 16:3, 149-160
Online publication date: 1-Jun-2009.
CrossRef
Pablo C. Okhuysen. (2007) Travelers?? Diarrhea, New Insights. Journal of Clinical Gastroenterology 41:Supplement 1, S20-S23
Online publication date: 1-Jun-2007.
CrossRef
Mary Ellen Sanders, Jeremy Hamilton, Gregor Reid, and Glenn Gibson. (2007) A Nonviable Preparation of Lactobacillus acidophilus Is Not a Probiotic. Clinical Infectious Diseases 44:6, 886-886
Online publication date: 15-Mar-2007.
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