Probiotics for the prevention and treatment of antibiotic-associated diarrhea: A systematic review and meta-analysis

Susanne Hempel, Sydne J. Newberry, Alicia R. Maher, Zhen Wang, Jeremy N V Miles, Roberta Shanman, Breanne Johnsen, Paul G. Shekelle

Research output: Contribution to journalReview article

408 Citations (Scopus)

Abstract

Context: Probiotics are live microorganisms intended to confer a health benefit when consumed. One condition for which probiotics have been advocated is the diarrhea that is a common adverse effect of antibiotic use. Objective: To evaluate the evidence for probiotic use in the prevention and treatment of antibiotic-associated diarrhea (AAD). Data Sources: Twelve electronic databases were searched (DARE, Cochrane Library of Systematic Reviews, CENTRAL, PubMed, EMBASE, CINAHL, AMED, MANTIS, TOXLINE, ToxFILE, NTIS, and AGRICOLA) and references of included studies and reviews were screened from database inception to February 2012, without language restriction. Study Selection: Two independent reviewers identified parallel randomized controlled trials (RCTs) of probiotics (Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and/or Bacillus) for the prevention or treatment of AAD. Data Extraction: Two independent reviewers extracted the data and assessed trial quality. Results: A total of 82 RCTs met inclusion criteria. The majority used Lactobacillusbased interventions alone or in combination with other genera; strains were poorly documented. The pooled relative risk in a DerSimonian-Laird random-effects metaanalysis of 63 RCTs, which included 11 811 participants, indicated a statistically significant association of probiotic administration with reduction in AAD (relative risk, 0.58; 95% CI, 0.50 to 0.68; P<.001; I 2, 54%; [risk difference, -0.07; 95% CI, -0.10 to -0.05], [number needed to treat, 13; 95% CI, 10.3 to 19.1]) in trials reporting on the number of patients with AAD. This result was relatively insensitive to numerous subgroup analyses. However, there exists significant heterogeneity in pooled results and the evidence is insufficient to determine whether this association varies systematically by population, antibiotic characteristic, or probiotic preparation. Conclusions: The pooled evidence suggests that probiotics are associated with a reduction in AAD. More research is needed to determine which probiotics are associated with the greatest efficacy and for which patients receiving which specific antibiotics.

Original languageEnglish (US)
Pages (from-to)1959-1969
Number of pages11
JournalJAMA - Journal of the American Medical Association
Volume307
Issue number18
DOIs
StatePublished - May 9 2012
Externally publishedYes

Fingerprint

Probiotics
Meta-Analysis
Diarrhea
Anti-Bacterial Agents
Randomized Controlled Trials
Databases
Numbers Needed To Treat
Saccharomyces
Bifidobacterium
Information Storage and Retrieval
Enterococcus
Lactobacillus
Insurance Benefits
Population Characteristics
Streptococcus
PubMed
Bacillus
Libraries
Language
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Probiotics for the prevention and treatment of antibiotic-associated diarrhea : A systematic review and meta-analysis. / Hempel, Susanne; Newberry, Sydne J.; Maher, Alicia R.; Wang, Zhen; Miles, Jeremy N V; Shanman, Roberta; Johnsen, Breanne; Shekelle, Paul G.

In: JAMA - Journal of the American Medical Association, Vol. 307, No. 18, 09.05.2012, p. 1959-1969.

Research output: Contribution to journalReview article

Hempel, Susanne ; Newberry, Sydne J. ; Maher, Alicia R. ; Wang, Zhen ; Miles, Jeremy N V ; Shanman, Roberta ; Johnsen, Breanne ; Shekelle, Paul G. / Probiotics for the prevention and treatment of antibiotic-associated diarrhea : A systematic review and meta-analysis. In: JAMA - Journal of the American Medical Association. 2012 ; Vol. 307, No. 18. pp. 1959-1969.
@article{ddc264c765264fd79b4a16e2c0eff5c1,
title = "Probiotics for the prevention and treatment of antibiotic-associated diarrhea: A systematic review and meta-analysis",
abstract = "Context: Probiotics are live microorganisms intended to confer a health benefit when consumed. One condition for which probiotics have been advocated is the diarrhea that is a common adverse effect of antibiotic use. Objective: To evaluate the evidence for probiotic use in the prevention and treatment of antibiotic-associated diarrhea (AAD). Data Sources: Twelve electronic databases were searched (DARE, Cochrane Library of Systematic Reviews, CENTRAL, PubMed, EMBASE, CINAHL, AMED, MANTIS, TOXLINE, ToxFILE, NTIS, and AGRICOLA) and references of included studies and reviews were screened from database inception to February 2012, without language restriction. Study Selection: Two independent reviewers identified parallel randomized controlled trials (RCTs) of probiotics (Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and/or Bacillus) for the prevention or treatment of AAD. Data Extraction: Two independent reviewers extracted the data and assessed trial quality. Results: A total of 82 RCTs met inclusion criteria. The majority used Lactobacillusbased interventions alone or in combination with other genera; strains were poorly documented. The pooled relative risk in a DerSimonian-Laird random-effects metaanalysis of 63 RCTs, which included 11 811 participants, indicated a statistically significant association of probiotic administration with reduction in AAD (relative risk, 0.58; 95{\%} CI, 0.50 to 0.68; P<.001; I 2, 54{\%}; [risk difference, -0.07; 95{\%} CI, -0.10 to -0.05], [number needed to treat, 13; 95{\%} CI, 10.3 to 19.1]) in trials reporting on the number of patients with AAD. This result was relatively insensitive to numerous subgroup analyses. However, there exists significant heterogeneity in pooled results and the evidence is insufficient to determine whether this association varies systematically by population, antibiotic characteristic, or probiotic preparation. Conclusions: The pooled evidence suggests that probiotics are associated with a reduction in AAD. More research is needed to determine which probiotics are associated with the greatest efficacy and for which patients receiving which specific antibiotics.",
author = "Susanne Hempel and Newberry, {Sydne J.} and Maher, {Alicia R.} and Zhen Wang and Miles, {Jeremy N V} and Roberta Shanman and Breanne Johnsen and Shekelle, {Paul G.}",
year = "2012",
month = "5",
day = "9",
doi = "10.1001/jama.2012.3507",
language = "English (US)",
volume = "307",
pages = "1959--1969",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "18",

}

TY - JOUR

T1 - Probiotics for the prevention and treatment of antibiotic-associated diarrhea

T2 - A systematic review and meta-analysis

AU - Hempel, Susanne

AU - Newberry, Sydne J.

AU - Maher, Alicia R.

AU - Wang, Zhen

AU - Miles, Jeremy N V

AU - Shanman, Roberta

AU - Johnsen, Breanne

AU - Shekelle, Paul G.

PY - 2012/5/9

Y1 - 2012/5/9

N2 - Context: Probiotics are live microorganisms intended to confer a health benefit when consumed. One condition for which probiotics have been advocated is the diarrhea that is a common adverse effect of antibiotic use. Objective: To evaluate the evidence for probiotic use in the prevention and treatment of antibiotic-associated diarrhea (AAD). Data Sources: Twelve electronic databases were searched (DARE, Cochrane Library of Systematic Reviews, CENTRAL, PubMed, EMBASE, CINAHL, AMED, MANTIS, TOXLINE, ToxFILE, NTIS, and AGRICOLA) and references of included studies and reviews were screened from database inception to February 2012, without language restriction. Study Selection: Two independent reviewers identified parallel randomized controlled trials (RCTs) of probiotics (Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and/or Bacillus) for the prevention or treatment of AAD. Data Extraction: Two independent reviewers extracted the data and assessed trial quality. Results: A total of 82 RCTs met inclusion criteria. The majority used Lactobacillusbased interventions alone or in combination with other genera; strains were poorly documented. The pooled relative risk in a DerSimonian-Laird random-effects metaanalysis of 63 RCTs, which included 11 811 participants, indicated a statistically significant association of probiotic administration with reduction in AAD (relative risk, 0.58; 95% CI, 0.50 to 0.68; P<.001; I 2, 54%; [risk difference, -0.07; 95% CI, -0.10 to -0.05], [number needed to treat, 13; 95% CI, 10.3 to 19.1]) in trials reporting on the number of patients with AAD. This result was relatively insensitive to numerous subgroup analyses. However, there exists significant heterogeneity in pooled results and the evidence is insufficient to determine whether this association varies systematically by population, antibiotic characteristic, or probiotic preparation. Conclusions: The pooled evidence suggests that probiotics are associated with a reduction in AAD. More research is needed to determine which probiotics are associated with the greatest efficacy and for which patients receiving which specific antibiotics.

AB - Context: Probiotics are live microorganisms intended to confer a health benefit when consumed. One condition for which probiotics have been advocated is the diarrhea that is a common adverse effect of antibiotic use. Objective: To evaluate the evidence for probiotic use in the prevention and treatment of antibiotic-associated diarrhea (AAD). Data Sources: Twelve electronic databases were searched (DARE, Cochrane Library of Systematic Reviews, CENTRAL, PubMed, EMBASE, CINAHL, AMED, MANTIS, TOXLINE, ToxFILE, NTIS, and AGRICOLA) and references of included studies and reviews were screened from database inception to February 2012, without language restriction. Study Selection: Two independent reviewers identified parallel randomized controlled trials (RCTs) of probiotics (Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and/or Bacillus) for the prevention or treatment of AAD. Data Extraction: Two independent reviewers extracted the data and assessed trial quality. Results: A total of 82 RCTs met inclusion criteria. The majority used Lactobacillusbased interventions alone or in combination with other genera; strains were poorly documented. The pooled relative risk in a DerSimonian-Laird random-effects metaanalysis of 63 RCTs, which included 11 811 participants, indicated a statistically significant association of probiotic administration with reduction in AAD (relative risk, 0.58; 95% CI, 0.50 to 0.68; P<.001; I 2, 54%; [risk difference, -0.07; 95% CI, -0.10 to -0.05], [number needed to treat, 13; 95% CI, 10.3 to 19.1]) in trials reporting on the number of patients with AAD. This result was relatively insensitive to numerous subgroup analyses. However, there exists significant heterogeneity in pooled results and the evidence is insufficient to determine whether this association varies systematically by population, antibiotic characteristic, or probiotic preparation. Conclusions: The pooled evidence suggests that probiotics are associated with a reduction in AAD. More research is needed to determine which probiotics are associated with the greatest efficacy and for which patients receiving which specific antibiotics.

UR - http://www.scopus.com/inward/record.url?scp=84860708876&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84860708876&partnerID=8YFLogxK

U2 - 10.1001/jama.2012.3507

DO - 10.1001/jama.2012.3507

M3 - Review article

C2 - 22570464

AN - SCOPUS:84860708876

VL - 307

SP - 1959

EP - 1969

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 18

ER -