- 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 .
- 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.
- Meta-analysis, data from 33 randomized controlled trials.
- Funding: Hospital for Sick Kids Foundation, Toronto, Ontario, Canada.
- Those of the included studies.