Probiotics show modest effect in preventing antibiotic-associated diarrhea

  • Guo Q & al.
  • Cochrane Database Syst Rev
  • 30 Apr 2019

  • International Clinical Digest
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Takeaway

  • Probiotics are modestly effective in preventing antibiotic-associated diarrhea (AAD) in children, say the authors of this updated Cochrane review.

Why this matters

  • AAD is a risk with antibiotic treatment, and probiotics have been proposed as a way to protect against it or shorten the duration.
  • This review updates a 2015 version . 

Key results

  • Studies tended to be short, 1-12 weeks.
  • Interventions: Lactobacilli, Bifidobacterium, Streptococcus, Saccharomyces boulardii alone or in combination vs placebo, no treatment, other putative AAD preventives (diosmectite, formula).
  • Probiotics tended to show preventive effect:
    • AAD with probiotics: 8%.
    • AAD in controls: 19%.
    • Pooled risk ratio: 0.45 (95% CI, 0.36-0.56; n=6352 participants).
    • Number needed to treat for benefit: 9 (95% CI, 7-13; moderate-certainty evidence).
  • Other analytic approaches yielded similar findings.
  • Limited, infrequent side effects mostly reported in control groups.
  • Authors say serious side effects have been reported in immunocompromised and other at-risk children, and to avoid probiotics in these patients, further research is pending.
  • Bias risk: high in 20, low in 13 studies.

Study design

  • Meta-analysis, data from 33 randomized controlled trials.
  • Funding: Hospital for Sick Kids Foundation, Toronto, Ontario, Canada.

Limitations

  • Those of the included studies.

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