Elsevier

The Journal of Pediatrics

Volume 149, Issue 3, September 2006, Pages 367-372.e1
The Journal of Pediatrics

Original article
Probiotics in the prevention of antibiotic-associated diarrhea in children: A meta-analysis of randomized controlled trials

https://doi.org/10.1016/j.jpeds.2006.04.053Get rights and content

Objective

To systematically evaluate the effectiveness of probiotics in preventing antibiotic-associated diarrhea (AAD) in children.

Study design

The following electronic databases up to December 2005, in any language, were searched for studies relevant to AAD and probiotics: MEDLINE, EMBASE, and The Cochrane Library. Only randomized controlled trials (RCT) were considered for study inclusion.

Results

Six placebo-controlled, RCTs (766 children) were included. Treatment with probiotics compared with placebo reduced the risk of AAD from 28.5% to 11.9% (relative risk, RR, 0.44, 95% CI 0.25 to 0.77, random effect model). Preplanned subgroup analysis showed that reduction of the risk of AAD was associated with the use of Lactobacillus GG (2 RCTs, 307 participants, RR 0.3, 95% CI 0.15 to 0.6), S. boulardii (1 RCT, 246 participants, RR 0.2, 95% CI 0.07-0.6), or B. lactis & Str. thermophilus (1 RCT, 157 participants, RR 0.5, 95% CI 0.3 to 0.95).

Conclusions

Probiotics reduce the risk of AAD in children. For every 7 patients that would develop diarrhea while being treated with antibiotics, one fewer will develop AAD if also receiving probiotics.

Section snippets

Search strategy

We searched: MEDLINE (1966 – December 2005), EMBASE (1980 – December 2005), Cumulative Index to Nursing and Allied Health (CINAHL, 1982 – December 2005), The Cochrane Database of Systematic Reviews (Issue 2, 2005), and The Cochrane Controlled Trials Register (CENTRAL) (Issue 4, 2005). The search strategy included use of a validated filter for identifying controlled trials,18 which was combined with a topic-specific strategy.

In brief, the search combined terms related to diarrhea

Description of studies

We initially identified 9 articles. Table I (available at www.jpeds.com) summarizes the characteristics of the 6 included trials.16, 17, 20, 21, 22, 23 The remaining 3 studies were excluded. Table II summarizes characteristics of the excluded trials,24, 25, 26 including the reasons for exclusion.

The 6 selected studies recruited a total of 766 participants (376 in the experimental group and 390 in the control group) who completed the follow-up interval. All studies were placebo controlled. There

Discussion

Our meta-analysis finds effectiveness of probiotics in preventing AAD in children treated with antibiotics for any reason (mainly for respiratory tract infections). For every 7 patients who would develop diarrhea while being treated with antibiotics, one fewer will develop AAD if also receiving probiotics. The results of this meta-analysis confirm the findings of previous systematic reviews, which included trials comparing probiotics with placebo or no treatment for prevention of AAD.11, 12, 13

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