Probiotics for the Prevention and Treatment of Antibiotic-Associated Diarrhea

Abstract

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 Lactobacillusbased interventions alone or in combination with other genera; strains were poorly documented. The pooled relative risk in a DerSimonian-Laird random-effects metaanalysis 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; PϽ.001; I 2 , 54%; [risk difference, −0.07; 95% CI, −0.10 to −0.05], [number needed to treat, 13; 95% CI, 10.3 to 19.1]) in trials reporting on the number of patients with AAD. This result was relatively insensitive to numerous subgroup analyses. However, there exists significant heterogeneity in pooled results and the evidence is insufficient to determine whether this association varies systematically by population, antibiotic characteristic, or probiotic preparation. Conclusions The pooled evidence suggests that probiotics are associated with a reduction in AAD. More research is needed to determine which probiotics are associated with the greatest efficacy and for which patients receiving which specific antibiotics.

Anti-Infective Activities of Lactobacillus Strains in the Human Intestinal Microbiota: from Probiotics to Gastrointestinal Anti-Infectious Biotherapeutic Agents

“…The advice is graded as "A," "B," "C," or no category. Classified in the A-grade advice are probiotic Lactobacillus strains used to treat acute childhood diarrhea (101) and C. difficile-associated diarrhea (102). Probiotic Lactobacillus strains used to treat chronic disorders of the gut, including IBD, are classified as having B-grade advice because there have been some negative studies (103).…”

“…Despite this lack of experimental evidence, the use of probiotic Lactobacillus strains to treat C. difficile-induced diarrhea has been extensively promoted in a high number of reviews (348-352), but it remains controversial (353). Meta-analyses have evidenced that probiotic strains are associated with a reduction in C. difficile-associated diarrhea (102,(354)(355)(356)(357). There were a small number of reports showing persuasive therapeutic effects against C. difficile-induced diarrhea after the administration of a single probiotic Lactobacillus strain.…”

Evaluation of probiotic potential of lactic acid bacteria isolated from traditional Malaysian fermentedBambangan(Mangifera pajang)

“…A large number of LAB, isolated from various fermented foods in different parts of the world, had been studied for their probiotic potential and ability to produce important substances for foods and pharmaceutical preparation (BautistaGallego et al, 2013;Monteagudo-Mera et al, 2012;Tham, Peh, Bhat, & Liong, 2012). LAB have become the focus of probiotic research internationally and their health benefits in the prevention of diarrhoea (Hempel et al, 2012), reduction of the cholesterol level (Jones, Martoni, & Prakash, 2012), relief of both irritable bowel syndrome (Ducrotté, Sawant, & Jayanthi, 2012) and milk allergy in infants (Kekkonen et al, 2008) are well documented. However, these properties cannot be extrapolated or generalised for all probiotic strains as such effects are strain-specific and a considerable number of works are still required to affirm the benefits of each probiotic candidate (Aureli et al, 2011).…”

Clinical update for the diagnosis and treatment ofClostridium difficileinfection

“…Systematic reviews and meta-analyses were completed for the use of probiotics in any AAD. In one analysis, the pooled results from 63 randomized control trials revealed a RR of 0.58 (95%CI: 0.50-0.68, P < 0.001) with an number needed to treat (NNT) of 13 [177] . Among those studies, a subset of 14 were randomized controlled trials for the prevention of CDI and pooled analysis revealed a RR of 0.29 (95%CI: 0.17-0.48, P < 0.001) with an NNT of 25.…”