Researchers at the National Spinal Injuries Centre (NSIC) in Stoke Mandeville Hospital, a research partner of the Centre of Gastroenterology and Clinical Nutrition at University College London, have found that a daily commercial probiotic drink (containing Lactobacillus casei Shirota: Yakult Light) significantly reduces incidence of antibiotic-associated diarrhoea in spinal injury patients.

The study, published today in the peer-reviewed British Journal of Nutrition, was funded by the Healthcare Infection Society and by Yakult UK Limited, who also provided the Yakult Light drinks.

Spinal injury patients are very prone to diarrhoea when on antibiotics. Antibiotics can disturb the ecosystem of micro-organisms normally present in the digestive system, allowing bacteria such as Clostridium difficile to overwhelm the gut.

The randomised controlled study involved 164 spinal injury patients prescribed antibiotics*. The patients were in two groups: one group taking a daily Yakult during the antibiotics and for one week afterwards, and the other group not taking any probiotic.

Antibiotic-associated diarrhoea developed in 54.9% of the patients not given probiotic, but in only 17.1% of those taking the Yakult. This was statistically a highly significant reduction.

Only one case of diarrhoea was diagnosed as being caused by Clostridium difficile over the 2 year study period: this was in the group of patients not given probiotic. There were no cases of C. difficile in the patients on Yakult. The study also identified poor appetite (i.e. risk of undernutrition) as a risk factor for developing antibiotic-associated diarrhoea.

Principal investigator, Dr. Samford Wong said: “Research into prevention of diarrhoea associated with antibiotic use and C. difficile is important, and we thought the probiotic approach was a good idea. We were surprised at how strong the study results were. It is important to remember that the probiotic effect is strain and condition specific, we don’t know if this will apply to other strains. We are now preparing a larger placebo-controlled study to confirm these findings, as this could be a significant benefit to our patients.”

Co-author Dr. Ali Jamous, Consultant Spinal Surgeon, commented ‘Quality of life is a large focus of research at the NSIC with patients being encouraged to participate in sports and supported into re-employment. If diarrhoea develops, their rehabilitation will be delayed, affecting not just the patient but also causing a lot of extra cost to the NHS. Given the severe loss of quality of life for these patients, a cost-effective, reliable and simple therapy would appear to be highly desirable. This is why we supported the current study and are keen to confirm these findings with a larger confirmatory trial.’

* The patients in the study had all sustained a spinal cord injury in the previous six months: approximately 80% of them were men; 74% of the patients had become injured through a traumatic injury.

This paper is freely available for one month

This post appears cortesy of NSIC for further information, contact the communications team on 01494 734959 or at

About the Author

Dr. Samford Wong (Research Dietitian and Research Associate at the NSIC and Centre for Gastroenterology and Clinical Nutrition at University College London) has been awarded the Spinal Cord Prize by the International Spinal Cord Society, and received the Mike Emmerson Young Investigator Award from the Healthcare Infection Society.

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