Established in 1927 by the American College of Physicians


13 November 2012 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 215-351-2653 or e-mail Angela Collom at

1. Prophylactic Probiotics Reduce Clostridium difficile-associated Diarrhea in Patients Taking Antibiotics

Prophylactic use of probiotics can reduce Clostridium difficile-associated diarrhea (CDAD). Clostridium difficile is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. CDAD most commonly affects older adults in hospitals or in long term care facilities and typically occurs after use of antibiotics. Probiotics are microorganisms thought to counteract disturbances in intestinal flora, and thereby reduce the risk of Clostridium difficile infection. Probiotics are inexpensive and readily available in capsules and dairy-based food supplements, making them an attractive option for the prevention of CDAD. Researchers reviewed 20 published randomized trials to assess the efficacy and safety of probiotics (any strain or dose) for the prevention of CDAD in adults and children receiving antibiotics. The evidence suggests that prophylactic use of probiotics reduces the incidence of CDAD in adults and children without risk for serious adverse events.

2. Epidural Corticosteroids Offer Only Short-term Relief from Sciatica Pain and Disability

Sciatica is a common type of low back pain characterized by intense unilateral leg pain, tingling or numbness, and shooting pain that radiates below the knee. Since symptoms of sciatica can be debilitating and persistent, patients are nearly four times more likely to have back surgery compared with those who have persistent low back pain only. Conservative treatment options often offer little relief, so more invasive procedures such as epidural corticosteroid injections have become increasingly popular. Currently, there are no clear guidelines for treating sciatica with epidural corticosteroid injections. Researchers reviewed published studies to determine the efficacy of epidural corticosteroid injections for reducing pain and disability from sciatica, compared to placebo controls. At short-term follow-up between two weeks and three months, 14 studies (n = 1,316 patients) showed that compared to placebo, corticosteroid injections offered significant relief from leg pain. Ten trials (n = 1,154) revealed a significant effect of epidural corticosteroid injections for reducing disability. Six trials (n = 723) showed that corticosteroid injections had no effect on back pain. Follow up at one year or later showed no difference in leg pain, back pain, or disability for patients given epidural corticosteroid injections or placebo.