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Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatients—A Systematic Review and Meta-Analysis
Open accessAbstract
A common adverse effect of antibiotic use is diarrhea. Probiotics are living microorganisms, which, upon oral ingestion, may prevent antibiotic-associated diarrhea (AAD) by the normalization of an unbalanced gastrointestinal flora. The objective of this systematic review was to assess the benefits and harms of probiotics used for the prevention of AAD in an outpatient setting. A search of the PubMed database was conducted and yielded a total of 17 RCTs with 3631 participants to be included in the review. A meta-analysis was conducted for the primary outcome: the incidence of AAD. The pooled results found that AAD was present in 8.0% of the probiotic group compared to 17.7% in the control group (RR 0.49, 95% CI 0.36 to 0.66; I2 = 58%), and the species-specific results were similar regarding the probiotic strains L. rhamnosus GG and S. boulardii. However, the overall quality of the included studies was moderate. A meta-analysis of the ten trials reporting adverse events demonstrated no statistically significant differences in the incidence of adverse events between the intervention and control group (RD 0.00, 95% CI −0.02 to 0.02, 2.363 participants). The results suggests that probiotic use may be beneficial in the prevention of AAD among outpatients. Furthermore, the use of probiotics appears safe.
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“In addition to modulating the immune system, the positive health effects of taking probiotics include: the improvement of lactose tolerance and digestion [199,205], the prevention and treatment of gastrointestinal infections [206], the prevention of colorectal cancer [203,207], reduction in blood cholesterol levels [208,209,210], and the improvement of mental health via the gut-brain axis [211].”
From Lactic Acid Bacteria in Raw-Milk Cheeses: From Starter Cultures to Probiotic Functions (2022) · cites this paper as [206]
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Prevention of Clostridium difficile Infection and Associated Diarrhea: An Unsolved Problem
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“69 antibiotic duration (days) (median, range) 27 (14-82) 28 (8-70) 0.”
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Johnson, T. M., Rivera, C. G., Lee, G., & Zeuli, J. D. (2024) · Journal of Clinical Tuberculosis and Other Mycobacterial Diseases · doi:10.1016/j.jctube.2024.100470 · Cited by 17
“Probiotic supplements or foods containing live bacterial cultures (yogurt, kefir) may be helpful for the management of antibiotic-associated diarrhea [151].”
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Hussein, L. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-819815-5.00055-0 · Cited by 14
El‐Saadony, M. T., Saad, A. M., Sitohy, M. Z., Alkafaas, S. S., Dladla, M., Ghosh, S., Mohammed, D. M., Ibrahim, E. H., Fahmy, M. A., Elkelish, A., et al. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2025.1713426 · Cited by 16
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“Specific probiotic strains have positive effects on atopic eczema [7], irritable bowel syndrome [8], diarrhea [9], and antibiotic-related diarrhea [10, 11].”
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MAMI: a comprehensive database of mother–infant microbiome and probiotic resources
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“For example, L. rhamnosus GG (LGG) has shown benefits in preventing antibiotic-associated diarrhea (AAD) ( 30 ) and eczema ( 31 ).”
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Lazebnik, L. B., Sarsenbaeva, A. S., Avalueva, E. B., Oreshko, L. S., Sitkin, S. I., Голованова, Е. В., Туркина, С. В., Khlynova, O. V., Sagalova, O., & Мирончев, О. В. (2021) · Экспериментальная и клиническая гастроэнтерология · doi:10.31146/1682-8658-ecg-188-4-7-67 · Cited by 12
Protective Effects of Bacillus subtilis HH2 against Oral Enterotoxigenic Escherichia coli in Beagles
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C. difficile biomarkers, pathogenicity and detection
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“Some yeasts different from lactic acid bacteria may also used as probiotics, such as Saccharomyces boulardii.([8]) Saccharomyces boulardii was used to prevent and treat antibiotic-related diarrhea since the 1950s and is one of the most common prescriptions,([9]) the double-blind study also confirmed the probiotic acti…”
BackgroundThe Use of Probiotics, Prebiotics, and Synbiotics as an Alternative to Antibiotics
Ranjan, A. (2022) · Springer eBooks · doi:10.1007/978-981-19-1854-4_18 · Cited by 9
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Metadata
- Authors
- Blaabjerg, S., Artzi, D., & Aabenhus, R.
- Affiliations
- University of Copenhagen (DK)
- Corresponding author
- Blaabjerg, Sara
- Artzi, Daniel
- Aabenhus, Rune
- ORCID
- Aabenhus, Rune
- Venue
- Antibiotics
- Publisher
- MDPI AG
- Published
- 2017-10-12
- Volume
- 6
- Issue
- 4
- Pages
- 21
- ISSN
- 2079-6382 (ISSN-L)
- PMC
- PMC5745464
- OpenAlex
- W2762238784
- Cited by
- 208
- References
- 29
- Citations by year
- 2026: 17 · 2025: 18 · 2024: 27 · 2023: 24 · 2022: 31 · 2021: 27 · 2020: 32 · 2019: 25 · 2018: 7
- FWCI
- 1.90
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Antibiotics (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- 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, outpatients, Lactobacillus rhamnosus GG, Saccharomyces boulardii, adverse events, gut microbiota, antibiotic adverse effects
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