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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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“Systemic review and meta-analyses suggest that the use of several species and strains of probiotics can have an overall positive effect in preventing AAD, by as much as 51% in some populations [6] [24] [25] [26] [27].”
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Українська медична стоматологічна академія, П., Скрипник, І. М., Приходько, Н. П., & Українська медична стоматологічна академія, П. (2021) · Український медичний часопис · doi:10.32471/umj.1680-3051.142.203410 · Cited by 2
“Інша група дослідників провела аналіз 17 досліджень з бази PubMed, що включали 3631 особу [43].”
Gut microbiota in COVID-19 treatment
Sadighpour, T., & Tolouian, A. (2021) · Immunopathologia Persa · doi:10.34172/ipp.2021.30
Kvit, A. D., Tutka, M. M., Laba, O. V., & Kunovskyi, V. V. (2021) · Wiadomości Lekarskie · doi:10.36740/wlek202107118
Hawrelak, J. A. (2020) · Elsevier eBooks · doi:10.1016/b978-0-323-43044-9.00105-9
Ajmal, D. S. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4064164
Enhancement of Probiotic Yogurts’ Characteristics using a 24-hour fermentation process
Ayoub, S., Alnaimi, N., Ibrahim, S., Manyama, J., Al-Marri, M., Naimi, A. J. A., Altamimi, A., Ansari, A. A., Esteban, C., Gaskell, C., et al. (2023) · Journal of Student Research · doi:10.47611/jsr.v11i3.1746
A Case of Recessive Dystrophic Epidermolysis Bullosa Associated Colitis
McCann, K. J., Wiss, K., Covington, J. D., Laffert, V., & Gosselin, K. B. (2023) · JPGN Reports · doi:10.1097/pg9.0000000000000313
Hiroshima University Affiliated Hospital Probiotics Usage Guidelines
Hiyama, T., Kunihiro, M., Asayama, N., Urabe, Y., Okanobu, H., Onogawa, S., Kunihiro, K., Kuwai, T., Kodama, M., Sanomura, Y., et al. (2023) · Nihon Daicho Komonbyo Gakkai Zasshi · doi:10.3862/jcoloproctology.76.467
van der Geest, A. M. (2023) · doi:10.5463/thesis.365
Gıda İşleme ve Üretiminde Yenilikçi Teknolojiler
Aydın, E., Karacabey, E., Küçüköner, E., Özkan, G., Buzrul, S., Baltacıoğlu, H., Coruk, K. S., Doğanay, G., Yetişen, M., Yavuzer, E., et al. (2024) · Akademisyen Kitabevi eBooks · doi:10.37609/akya.2922
Kalra, S., Joshi, A. S., TIWASKAR, M. H., Agrawal, N. K., Shaikh, S. S., Bhatia, B. S., Jhingan, A. K., Rawal, P., Das, A. K., Nishad, S. K., et al. (2023) · Journal of the Association of Physicians of India · doi:10.59556/japi.71.0409
Disboyizisin Önlenmesi ve Sağlıklı Mikrobiyota Gelişimi için Probiyotikler
Çakır, A., Arslan, M., Sadioglu, O. D., Akdemir, T., Az, A., Güven, Ş., Ümit, T. B., Helvaci, M. S., Çalık, M., Coşkun, A., et al. (2024) · Akademisyen Kitabevi eBooks · doi:10.37609/akya.3110
Probiotics and its Application in Humans: An Overview
Arunavarsini, K., Yuvansasi, V. , Sekar, M., Durga Devi., L., & Mahenthiran, R. (2024) · Journal of Pharmaceutical Research International · doi:10.9734/jpri/2024/v36i77552
Nikolaeva, I. V., Shaikhieva, G. S., & GAYNATULLINA, L. R. (2024) · Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics) · doi:10.21508/1027-4065-2024-69-5-45-51
吕, 文. (2024) · Advances in Clinical Medicine · doi:10.12677/acm.2024.14113016
Efficacy of Bacillus clausii UBBC-07 in the prevention of antibiotic-associated diarrhea in children
Бекетова, Г. В., Koiro, O., Bohdanova, S. S., Bulhakova, M. S., Heorhitsa, K. M., Il’kiv, O. B., Kavka, О. R., Kmit’, О. Z., Kukhar, О. V., Liubetska, V. І., et al. (2024) · CHILD`S HEALTH · doi:10.22141/2224-0551.19.7.2024.1758
Willemse, T. W. J., & Schmitz, S. S. (2024) · Vlaams Diergeneeskundig Tijdschrift · doi:10.21825/vdt.93194
The role of Bifidobacterium animalis QC08 in antibiotic-associated diarrhea in mice
Ren, L., Tan, F., Kim, H., Ma, X., & Kong, C. (2025) · Food Science and Biotechnology · doi:10.1007/s10068-025-01881-4
“This increases the risk of enterogenic infections, ultimately contributing to AAD pathogenesis (Blaabjerg et al., 2017).”
REAÇÕES ADVERSAS E INTERAÇÕES MEDICAMENTOSAS DOS ANTICONCEPCIONAIS HORMONAIS: PERCEPÇÃO DE MULHERES
de Oliveira, M., da Silva, S. C., Pereira, A. D., da Silveira, A., Marques, K. A., Silveira, J. O., Nunes, J. B., & Soccol, K. L. S. (2025) · Revista Enfermagem Atual In Derme · doi:10.31011/reaid-2025-v.99-n.3-art.2550
Function of Gut Microbiota in Longevity as a Futuristic Approach of Personalised Nutrition
Malik, S., Bharali, R., Barbhuyan, H. S. A., Bora, J., Lata, S., & Madan, A. (2026) · IGI Global eBooks · doi:10.4018/979-8-3373-4382-2.ch010 · Cited by 1
91Chapter 4 Probiotics and Gut Microbiota: A Comprehensive Study of Their Interactions and Benefits
Priti, Verma, K., Goyal, S., Praveen, K., Charulata, Gupta, B., & Bansal, P. (2025) · De Gruyter eBooks · doi:10.1515/9783112205150-004
Salahi‐Niri, A., Sadeghı, A., Mokhtare, M., Avanaki, F. A., Taher, M., Mirshahvelayati, A., Zali, M. R., Sadeghi, A., & Yadegar, A. (2026) · Helicobacter · doi:10.1111/hel.70137
“However, the elderly population is not at a higher risk of encountering side effects [131].”
Probiotics in the Prevention and Management of Antibiotic-Resistant Infections
Marzi, M., & Tunç, A. K. (2026) · Fenerbahçe Üniversitesi Sağlık Bilimleri Dergisi · doi:10.56061/fbujohs.1817657
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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