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In this issue Lenoir-Wijnkoop et al. (2014) show that an affordable and widely available fermented dairy drink containing a known and well-documented probiotic could lead to health care system cost savings. This paper is just one in a surprisingly large number of very recent papers on probiotics, antibiotic-associated diarrhea (AAD), and Clostridium difficile-associated diarrhea (CDAD, recurrent-CDAD, or CD infection: CDI). The revival of attention for CDI is mainly caused by the emergence of new hyper virulent strains, a decrease of clinical response to antibiotics, an increase of incidence and prevalence and the existence of at least three different toxins. Clostridium difficile has a broad clinical manifestation from asymptomatic (contagious) carriers, via diarrhea toward pseudomembranous colitis, toxic megacolon, and death. Since Clostridium difficile is a spore former it can still cause endogenous self-contamination even (or especially) after antibiotic treatment. Furthermore, these spores are a contamination hazard in health care facilities and they heighten the transmission rates (R-value). Taken together, all these factors (reviewed in Hell et al., 2013) result in a high unmet medical need with significant socio-economic impact. Here, we would like to put both the clinical and economic impact of this paper in a broader “state of the art” context, by adding alternative new insights and references not yet available to the Lenoir-Wijnkoop paper.

Cost-benefit relation of diet and probiotics in iatrogenic bowel irregularity (IBI)