Meta-analysis supports efficacy of probiotic for preventing antibiotic-associated diarrhea
A recent systematic review and meta-analysis showed moderate-to-low quality evidence that the probiotic Lactobacillus rhamnosus GG effectively prevents antibiotic-associated diarrhea in both children and adults.
As part of the development of guidelines on the prophylactic use of probiotics for preventing antibiotic-associated diarrhea in children, researchers from the department of pediatrics at the Medical University of Warsaw in Poland reviewed data from 12 randomized controlled trials published up to July 2015 evaluating Lactobacillus rhamnosus GG (LGG, Dicofarm) for the prevention of antibiotic-associated diarrhea in children and adults treated with antibiotics for any reason (n = 1,499).
“The effects of probiotics are strain specific. The clinical effects of each strain need to be evaluated separately,” the researchers wrote. “The choice of the LGG strain was determined by the fact that it is widely available in many countries and is commonly used.”
The daily dose of LGG ranged from 4 x 108 to 12 x 1010 colony forming units, types of antibiotics received varied widely, and follow-up ranged from 10 days to 3 months.
Data from 11 of the included RCTs (n = 1,308) showed LGG reduced the risk for antibiotic-associated diarrhea from 22.4% to 12.3% compared with placebo or no additional treatment (RR = 0.49; 95% CI, 0.29-0.83), although based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, the quality of this evidence was low.
Moderate quality data from five of the included RCTs evaluating children (n = 445) showed the reduced risk for antibiotic-associated diarrhea (23% to 9.6%) was only significant in pediatric patients (RR = 0.48; 95% CI, 0.26-0.89).
Low quality evidence from four RCTs (n = 280) showed the reduced risk among adults was only significant in those who received antibiotics as part of Helicobacter pylori eradication therapy (RR = 0.26; 95% CI, 0.11-0.59).
Based on data from eight of the included RCTs, LGG was well tolerated and adverse events were comparable between treatment and control groups.
“In summary, current evidence justified the use of LGG for preventing [antibiotic-associated diarrhea], although a number of questions remain unanswered and the [quality of evidence] calls for caution,” the researchers concluded. – by Adam Leitenberger
Disclosures: Szajewska reports she has served as a speaker for Dicofarm, the manufacturer of LGG.