Introduction

Clindamycin is frequently prescribed in dentistry. The spread of clindamycin resistance among Clostridioides difficile strains and associated severe side effects have triggered patients’ concern. The extent of this concern and how it is addressed were investigated in this study. Pro- or synbiotics have been suggested to prevent antibiotic-induced C. difficile infection (CDI). In vitro experiments were performed to evaluate what role these products can play in managing clindamycin-resistant CDI and which product features might be beneficial.

Material and methods

A survey among German dentists evaluated the importance of side effects of anti­biotics during discussions with patients, clindamycin usage and whether co-administration of pro- or synbio­tics is recommended. Three different C. difficile strains were characterized by antibiotic susceptibility testing (AST) and the possibility to inhibit their in vitro growth by products containing probiotic microorganisms.

Results

All respondents claimed that side effects of antibiotics are a topic of discussion with patients, 92% reported using clindamycin. 6% of respondents stated that they did not recommend pro- or synbiotics, while 67% claimed to make this recommendation with each antibiotic prescription. AST of the three investigated C. difficile strains revealed resistance against clindamycin (and other antibiotics) of the C. difficile ribotype 001 strain No. 977 and the ribotype 027 strain No. 644. In vitro inhibition experiments showed that all three strains could be best inhibited by multi-strain synbiotic preparations.

Conclusions

The recommendation to co-administer pro- or synbiotics together with clindamycin can be used to address concerns of patients. The results of this study support this approach and provide some guidance for product selection.