Probiotics and prevention of Clostridium difficile infection

•There is increasing evidence of the efficacy of probiotics in primary prevention of CDI.•Only three probiotics have been studied for CDI activity: BioK+, Lactobacillus rhamnosus GG and Saccharomyces boulardii.•The value of probiotics in CDI is confused from combining primary & secondary prophylaxis, & different strains into pooled analyses.

The role of probiotics as adjunctive measures in the prevention of Clostridium difficile infection (CDI) has been controversial. However, a growing body of evidence has suggested that they have a role in primary prevention of CDI. Elements of this controversy are reviewed and the proposed mechanisms of action, the value and cost effectiveness of probiotics are addressed with a focus on three agents, Saccharomyces boulardii, Lactobacillus rhamnosus GG and the combination of Lactobacillus acidophilus CL1285, Lactobacillus casei LBC80R, Lactobacillus rhamnosus CLR2 (Bio-K+).