Probiotics for the prevention of antibiotic-associated diarrhoea: a systematic review and meta-analysis

This review of 42 RCTs (n=11,305) found moderate evidence that co-administration of probiotics with antibiotics reduces risk of antibiotic-associated diarrhoea (RR 0.63; 95 % CI 0.54-0.73; p<0.00001). Subgroup analyses suggest benefit in those at moderate to high baseline risk.

SPS commentary:

The authors note their findings are concordant with those from a previous Cochrane review (RR 0.58; 95 CI 0.48-0.70), and they included 18 additional studies. They estimate that 20 patients would need to be treated to prevent one case of antibiotic-associated diarrhoea. Subgroup analyses suggested high doses were more effective than lower doses, and some species were more effective than others. The authors note that the utility of this review in clinical practice would have been improved by also analysing duration of antibiotic-associated diarrhoea, diarrhoea severity, need for hospitalisation due to diarrhoea and quality of life measures.

BMJ Open