Probiotics for the Prevention and Treatment of Antibiotic-Associated Diarrhea: A Systematic Review and Meta-analysis

CONTEXT Probiotics are live microorganisms intended to confer a health benefit when consumed. One condition for which probiotics have been advocated is the diarrhea that is a common adverse effect of antibiotic use. OBJECTIVE To evaluate the evidence for probiotic use in the prevention and treatment...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 2012-05, Vol.307 (18), p.1959-1969
Main Authors: Hempel, Susanne, Newberry, Sydne J, Maher, Alicia R, Wang, Zhen, Miles, Jeremy N. V, Shanman, Roberta, Johnsen, Breanne, Shekelle, Paul G
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - adverse effects
Anti-Bacterial Agents - therapeutic use
Antibacterial agents
Antibiotics. Antiinfectious agents. Antiparasitic agents
Bacillus
Bifidobacterium
Biological and medical sciences
Diarrhea
Diarrhea - chemically induced
Diarrhea - prevention & control
Disease prevention
Enterococcus
General aspects
Humans
Lactobacillus
Medical sciences
Medical treatment
Meta-analysis
Pharmacology. Drug treatments
Prevention and actions
Probiotics
Probiotics - therapeutic use
Public health. Hygiene
Public health. Hygiene-occupational medicine
Randomized Controlled Trials as Topic
Saccharomyces
Streptococcus
Systematic review
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Summary:CONTEXT Probiotics are live microorganisms intended to confer a health benefit when consumed. One condition for which probiotics have been advocated is the diarrhea that is a common adverse effect of antibiotic use. OBJECTIVE To evaluate the evidence for probiotic use in the prevention and treatment of antibiotic-associated diarrhea (AAD). DATA SOURCES Twelve electronic databases were searched (DARE, Cochrane Library of Systematic Reviews, CENTRAL, PubMed, EMBASE, CINAHL, AMED, MANTIS, TOXLINE, ToxFILE, NTIS, and AGRICOLA) and references of included studies and reviews were screened from database inception to February 2012, without language restriction. STUDY SELECTION Two independent reviewers identified parallel randomized controlled trials (RCTs) of probiotics (Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and/or Bacillus) for the prevention or treatment of AAD. DATA EXTRACTION Two independent reviewers extracted the data and assessed trial quality. RESULTS A total of 82 RCTs met inclusion criteria. The majority used Lactobacillus -based interventions alone or in combination with other genera; strains were poorly documented. The pooled relative risk in a DerSimonian-Laird random-effects meta-analysis of 63 RCTs, which included 11 811 participants, indicated a statistically significant association of probiotic administration with reduction in AAD (relative risk, 0.58; 95% CI, 0.50 to 0.68; P 
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.2012.3507