Probiotics for Antibiotic-Associated Diarrhoea (PAAD): a prospective observational study of antibiotic-associated diarrhoea (including Clostridium difficile-associated diarrhoea) in care homes

PAAD stage 1 (11 Welsh care homes; n=260) found those in nursing homes frequently prescribed antibiotics and often experience AAD. Resistance, including to ciprofloxacin, is common in Enterobacteriaceae from stool of care home residents. Co-amoxiclav linked to greater AAD risk.

The PAAD study was designed as a two-stage study. PAAD stage 1 was a prospective observational cohort study in care homes in South Wales with up to 12 months’ follow-up for each resident. It aimed to:

 

(1) prospectively describe antibiotic prescribing in care homes

 

(2) determine the incidence of C. difficile carriage and AAD (including C. difficile-associated diarrhoea)

 

(3) to consider implementation challenges and establish the basis for a sample size estimation for an RCT of probiotic administration with antibiotics to prevent AAD in care homes.

If justified by PAAD stage 1, the RCT would be implemented in PAAD stage 2. However, as a result of new evidence regarding the clinical effectiveness of probiotics on the incidence of AAD, a decision was taken not to proceed with PAAD stage 2.