Probiotics for the prevention of antibiotic-associated diarrhea and Clostridium difficile infection among hospitalized patients: systematic review and meta-analysis.

2. Article – Probiotics for the prevention

Citation:

Pattani R, Palda VA, Hwang SW, Shah PS. Probiotics for the prevention of antibiotic-associated diarrhea and Clostridium difficile infection among hospitalized patients: systematic review and meta-analysis. Open Med. 2013;7(2):e56-e67. Published 2013 May 28.

Article Summary:

Antibiotics can disturb gastrointestinal microbiota which may lead to reduced resistance to pathogens such as Clostridium difficile. A rise in the use of antibiotics has resulted in a marked increase in antibiotic-associated diarrhea. Probiotics are live microbial preparations that may confer a health benefit to the host and are a potential C. difficile prevention strategy. However, the efficacy of probiotics for preventing antibiotic-associated diarrhea are inconclusive.

Systematic searches of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were undertaken on May 31, 2012, to identify relevant publications. They searched for randomized controlled trials of adult inpatients who were receiving antibiotics and who were randomly assigned to co-administration of probiotics or usual care. Meta-analyses were performed using a random-effects model, and pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated.

The results of this study indicate:

• For short follow-up periods (<4 weeks), statistically significant reductions in both AAD and CDI were observed among patients randomly assigned to co-administration of probiotics.
• With longer follow-up, only the reduction in AAD, and not that for CDI, remained significant.
• No life-threatening adverse effects of probiotics were reported in this study.
• Probiotics had an excellent safety profile, the most common adverse effect being gastrointestinal upset.

Based on the above evidence, this study succeeds to provide consistent evidence of the protective effect of probiotics on risk of antibiotic-associated diarrhea in adult patients. Even though probiotics have the highest quality evidence among cited prophylactic therapies, recent clinical practice guidelines do not recommend probiotic prophylaxis. This may be because of the small sample sizes in the individual trials. According to the AGA Clinical Practice Guideline which is published in 2020, for patients who place a high value on avoidance of potential harms, particularly those with severe illnesses or immunosuppression, it would be reasonable to select not to use probiotics. While there was evidence for probiotics in the prevention of C difficile, the technical review found significant knowledge gap in the use of probiotics in treatment of C difficile and recommend this as an area for further study. Similar knowledge gaps exist in the use of probiotics in irritable bowel syndrome and inflammatory bowel disease (Crohn’s disease and ulcerative colitis).