Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis

Abstract

Objective: To evaluate efficacy of probiotics in prevention and treatment of diarrhoea associated with the use of antibiotics.

Design: Meta-analysis; outcome data (proportion of patients not getting diarrhoea) were analysed, pooled, and compared to determine odds ratios in treated and control groups.

Identification: Studies identified by searching Medline between 1966 and 2000 and the Cochrane Library. Studies reviewed Nine randomised, double blind, placebo controlled trials of probiotics.

Results: Two of the nine studies investigated the effects of probiotics in children. Four trials used a yeast (Saccharomyces boulardii), four used lactobacilli, and one used a strain of enterococcus that produced lactic acid. Three trials used a combination of probiotic strains of bacteria. In all nine trials, the probiotics were given in combination with antibiotics and the control groups received placebo and antibiotics. The odds ratio in favour of active treatment over placebo in preventing diarrhoea associated with antibiotics was 0.39 (95% confidence interval 0.25 to 0.62; P<0.001) for the yeast and 0.34 (0.19 to 0.61; P<0.01 for lactobacilli. The combined odds ratio was 0.37 (0.26 to 0.53; P<0.001) in favour of active treatment over placebo.

Conclusions: The meta-analysis suggests that probiotics can be used to prevent antibiotic associated diarrhoea and that S boulardii and lactobacilli have the potential to be used in this situation. The efficacy of probiotics in treating antibiotic associated diarrhoea remains to be proved. A further large trial in which probiotics are used as preventive agents should look at the costs of and need for routine use of these agents.

Figures

Figure 1

Funnel plot of odds ratio against sample size

Figure 2

Funnel plot using data from Begg and Mazumdar's adjusted rank correlation test

Figure 3

Plot of publication bias using data from Egger et al's regression asymmetry test; 95% confidence interval is given between markers at x=0

Figure 4

Meta-analysis profile summarising flow trials. RCT=randomised controlled trial

Figure 5

Plot of the log of odds ratios for the proportion of patients free of diarrhoea in treatment groups compared with control groups