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Probiotics for the Prevention and Treatment of Antibiotic-Associated Diarrhea: A Systematic Review and Meta-analysis
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 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 < .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.
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“Our subgroup analyses found similarly to one previous meta-analysis37 that the Lactobacillus and Saccharomyces genera reduced incidence of AAD.”
From Probiotics for the prevention of antibiotic-associated diarrhoea: A systematic review and meta-analysis (2021) · cites this paper as [37]
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Metadata
- Authors
- Newberry, S. J.
- Affiliations
- RAND Corporation (US)
- Corresponding author
- Newberry, Sydne J.
- ORCID
- Newberry, Sydne J.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2012-05-09
- Volume
- 307
- Issue
- 18
- Pages
- 1959
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W1966875539
- Cited by
- 870
- References
- 92
- Citations by year
- 2026: 36 · 2025: 51 · 2024: 49 · 2023: 49 · 2022: 75 · 2021: 64 · 2020: 52 · 2019: 71 · 2018: 42 · 2017: 50 · 2016: 64 · 2015: 90 · 2014: 66 · 2013: 78 · 2012: 32
- FWCI
- 130.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Public Health Service (290-2007-10062-I)
- Topics
- Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- probiotics, antibiotic-associated diarrhea, diarrhea prevention, Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, Bacillus, antibiotic adverse effects, probiotic efficacy
- MeSH terms
- Anti-Bacterial Agents, Diarrhea, Humans, Randomized Controlled Trials as Topic, Probiotics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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