Its new provider time in the ED! Rather than focus on something cutting edge, lets go back to basics and talk about something we write for just about every shift: antibiotics.
Specifically, the risk of C. difficile and its association with antibiotics. Approximately 1 % of all admitted patients, 13 % of patients with stays up two 2 weeks, and 50% of patients with stays >4 weeks contract symptomatic, need-to-be-treated, (and sometimes need to be admitted), C diff.
ED favorites, such as cephalosporins, fluoroquinolones, and MRSA fighting clindamycin have been heavily implicated.
A 2012 meta-analysis was done looking at 20 trials and including almost 4000 patients. Probiotics of any sort reduced the relative risk of Cdiff by 66% ie, NNT 30. Total adverse events with probiotics- 9.3% vs 12.6% without.
Given that many stock discharge instructions encourage patients to stop smoking, wear seatbelts, or have CHF-related diet modifications (despite whether or not they smoke, drive, or have CHF!), I see no reason why you could not add a blurb to your discharge instructions about adding a probiotic to their diet while on antibiotics. Probiotics- at $15 for 90 tabs- wont break the bank either. So, while the NNT could be better, its a cheaper option than PO flagyl, a repeat ED visit, and time off from work.