Do synbiotics reduce infections after bowel surgery?

The intervention is a synbiotic powder manufactured by the Sydney based company ProGood. Synbiotics are a combination of probiotics and prebiotics. Probiotics and synbiotics are classified as food supplements, not medicines. The selected synbiotic product is called 'ProGood Original' and it contains the following probiotics and prebiotics: - 15 billion Lactobacillus acidophilus - 15 billion Bifidobacterium lactis - Arabinoglobulin - Inulin This synbiotic product was selected because of the presence of two commonly used probiotic species (Lactobacillus acidophilus and Bifidobacterium lactis) that appeared to be less prevalent as sources of bacteraemia in case reports, as opposed to other probiotic species. Of note, probiotic-induced bacteraemia is a rare outcome with documentation in isolated case reports and often in patients with severe immunosuppression. Nonetheless, we wanted to focus on selecting a synbiotic product that was as safe as possible for our randomised controlled trial. Participants randomised to the intervention group will be given a plain container containing 105g of synbiotic powder, and a scoop. They will be asked to take orally 5 grams (approximately 1 heaped teaspoon) synbiotic powder mixed in with a glass of water once daily for 1 week before surgery, in their own home. They will not take the synbiotic powder on the day of surgery, but they will bring the container to hospital for storage. They will take the synbiotic powder for two weeks after surgery. If they are nil by mouth after surgery due to a complication such as an ileus, they will not be required to take the powder on the days that they are nil by mouth. Instead, they will return to taking it when they are able to tolerate oral medications. Nursing staff will assist with administration of the synbiotic powder in hospital. The container will be required to be stored in a refrigerator to ensure that the synbiotic powder is stored at a temperature under 8 degrees. If the participant is discharged before two weeks after surgery, they will be given their synbiotic container to complete the two week course at home. Participants will be provided with a chart to document days of successfully taking the synbiotic powder. The synbiotic container will be collected by the researcher at the end of the participant's three week course, to assess adherence.