Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatients—A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Results
2.1. Description of Studies
2.1.1. Results of the Search
2.1.2. Design
2.1.3. Patient Population
2.1.4. Interventions
2.1.5. Comparison
2.1.6. Outcomes
2.2. Risk of Bias in Included Studies
2.3. Effects of Interventions
2.3.1. Main Outcome: Incidence of Antibiotic-Associated Diarrhea
2.3.2. Secondary Outcome: Incidence of Antibiotic-Associated Diarrhea Using the Criteria Defined by WHO
2.3.3. Secondary Outcome: Mean Duration of Diarrhea
2.3.4. Secondary Outcome: Incidence of Adverse Events
2.3.5. Dose-Response Analysis
2.4. Subgroup Analyses
2.4.1. Age Groups
2.4.2. Trials with H. pylori Eradication Therapy
2.4.3. Low Risk of Bias
2.4.4. Intention-To-Treat Analyses
3. Discussion
4. Materials and Methods
4.1. Criteria for Selecting Studies for This Review
4.1.1. Types of Studies
4.1.2. Types of Participants
4.1.3. Types of Interventions
4.1.4. Types of Outcome Measures
- Incidence of antibiotic-associated diarrhea (AAD)
- Incidence of AAD using the criteria defined by WHO:
- Mean duration of diarrhea (MDD) in days
- Number and types of adverse events
4.2. Search Methods for Identification of Studies
4.3. Data Collection and Analysis
4.3.1. Study Selection
4.3.2. Data Extraction and Management
4.3.3. Quality Assessments
4.3.4. Statistical Analysis
5. Conclusions
Supplementary Materials
Acknowledgments
Author Contributions
Conflicts of Interest
References
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RCT | Probiotic(s) Used (Genus and Strain) | Dosage | Duration of Treatment |
---|---|---|---|
Tankanow et al., 1990 [7] | Lactobacillus acidophilus Lactobacillus bulgaricus | 5.1 × 108 CFU, four times daily | 10 days |
Vanderhoof et al., 1999 [8] | Lactobacillus rhamnosus GG | Children < 12 kg: 1 × 1010 CFU, once daily Children > 12 kg: 2 × 1010, once daily | 10 days |
Arvola et al., 1999 [9] | Lactobacillus rhamnosus GG | 2 × 1010 CFU, twice daily | Seven to 10 days |
Erdeve et al., 2004 [10] | Saccharomyces boulardii | Not mentioned | Not mentioned |
Duman et al., 2005 [11] | Saccharomyces boulardii | 500 mg, twice daily | 14 days |
Park et al., 2007 [12] | Bacillus subtilis Streptococcus faecium | two capsules three times a day: 2.5 × 109 CFU (Bacillus subtilis) 22.5 × 109 CFU (Streptococcus faecium) | Eight weeks |
Cindoruk et al., 2007 [13] | Saccharomyces boulardii | 500 mg, twice daily | 14 days |
Conway et al., 2007 [14] | Lactobacillus acidophilus | 109 CFU, once daily | 12 days |
Streptococcus thermophilus | |||
Bifidobacterium animalis lactis | |||
Imase et al., 2008 [15] | Clostridium butyricum | 1 × 107 CFU per tablet Group B: two tablets, three times daily Group C: 4 tablets, three times daily | Seven days |
Kim et al., 2008 [16] | Lactobacillus acidophilus Lactobacillus casei Bifidobacterium longum Streptococcus thermophilus | One bottle (150 mL) per day: >1 × 105 CFU/mL (L. acidophilus) >1 × 105 CFU/mL (L. casei) >1 × 106 CFU/mL (B. longum) >1 × 108 CFU/mL (S. themophilus) | At least three weeks |
Merenstein et al., 2009 [17] | Lactococcus lactis Lactococcus plantarum Lactococcus rhamnosus Lactococcus casei Lactococcus lactis subspecies diacetylactis Leuconostoc cremoris Bifidobacterium longum Bifidobacterium breve Lactobacillus acidophilus Saccharomyces florentinus | One bottle (150 mL) per day, amount of CFU not mentioned | 10 days |
De Vrese et al., 2011 [18] | Lactobacillus acidophilus LA-5 Bifidobacterium lactis BB-12 | >1 × 106 CFU/g, 125 g, twice daily | Five weeks |
Ojetti et al., 2013 [19] | Lactobacillus reuteri | 1 × 108 CFU, three times daily | 14 days |
Chatterjee et al., 2013 [20] | Lactobacillus acidophilus La-5, | 4 × 109 CFU | 14 days |
Bifidobacterium Bb-12 | |||
Zojaji et al., 2013 [21] | Saccharomyces boulardii | 250 mg twice daily, amount of CFU not mentioned | 14 days |
Fox et al., 2014 [22] | Lactobacillus rhamnosus, G.G.; Lactobacillus acidophilus LA-5, Bifidobacterium Bb-12 | 5.2 × 109 CFU (L. rhamnosus) 5.9 × 109 CFU (B. Bb-12) 8.3 × 109 CFU (L. acidophilus LA-5) | Number of days not mentioned (“From the start to the end of their antibiotic treatment”) |
Olek et al., 2017 [23] | Lactobacillus plantarum DSM9843 (LP299V) | 1 × 1010 CFU/capsule | Five to 10 days during antibiotic treatment and one week after (± two days) |
RCT | Definition of Diarrhea |
---|---|
Tankanow et al., 1990 | One or more abnormally loose bowel movements/day throughout the study period of one to 10 days (parental reports) |
Vanderhoof et al., 1999 | The presence of at least two liquid stools/day during at least two observation periods during the course of the study |
Arvola et al., 1999 | At least three watery or loose stools/day for a minimum of two consecutive days |
Erdeve et al., 2004 | Three or more watery stools/day during antibiotic treatment |
Duman et al., 2005 | A change in bowel habits with at least three semi-solid or watery bowel movements/day for at least two consecutive days |
Park et al., 2007 | Not specified (self-report) |
Cindoruk et al., 2007 | Not specified (modified De Boer questionnaire categorizing diarrhea into “none”, “mild”, “moderate” and “severe”) |
Conway et al., 2007 | Three or more loose stools/day over at least two consecutive days during the 12-day follow-up period |
Imase et al., 2008 | “Loose or mostly loose stools”, not specified further |
Kim et al., 2008 | Not specified other than categorized in groups (“none”, “mild”, “moderate”, “severe”) |
Merenstein et al., 2009 | Not specified (parental reports) |
De Vrese et al., 2011 | Three or more watery stools for at least one day (where at least one episode lay within the eradication week) |
Ojetti et al., 2013 | Not specified other than categorized in groups (“none”, “mild”, “moderate”, “severe”) |
Chatterjee et al., 2013 | Passage of at least three or more watery or loose stools/day for at least two consecutive days |
Zojaji et al., 2013 | Not specified (self-report) |
Fox et al., 2014 | Categories: |
“A” (stool consistency ≥ 5, ≥2 stools/day for ≥2 days) | |
“B” (stool consistency ≥ 5, ≥3 stools/day for ≥2 days) | |
“C” (stool consistency ≥ 6, ≥2 stools/day for ≥2 days) | |
“D” (stool consistency ≥ 6, ≥3 stools/day for ≥2 days) | |
Olek et al., 2017 | ≥3 loose/watery stools/24 h starting after the initiation of antibiotic treatment |
MDD (Days) | Range | Probiotic Group (N) | MDD (Days) | Range | Control Group (N) | |
---|---|---|---|---|---|---|
Vanderhoof et al., 1999 | 4.70 | N/A | 93 | 5.88 | N/A | 95 |
Arvola et al., 1999 | 4.00 | 2–8 | 61 | 4.00 | 2–8 | 58 |
De Vrese et al., 2011 | 1.00 | N/A | 30 | 4.70 | N/A | 29 |
Chatterjee et al., 2013 | 2.00 | 1–3 | 198 | 4.00 | 3–5.5 | 198 |
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Blaabjerg, S.; Artzi, D.M.; Aabenhus, R. Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatients—A Systematic Review and Meta-Analysis. Antibiotics 2017, 6, 21. https://doi.org/10.3390/antibiotics6040021
Blaabjerg S, Artzi DM, Aabenhus R. Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatients—A Systematic Review and Meta-Analysis. Antibiotics. 2017; 6(4):21. https://doi.org/10.3390/antibiotics6040021
Chicago/Turabian StyleBlaabjerg, Sara, Daniel Maribo Artzi, and Rune Aabenhus. 2017. "Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatients—A Systematic Review and Meta-Analysis" Antibiotics 6, no. 4: 21. https://doi.org/10.3390/antibiotics6040021