Probiotics for the Prevention of Antibiotic-Associated Diarrhea

Clinical QuestionDo probiotics reduce the risk of Antibiotic-Associated Diarrhea (AAD) in adult patients? Evidence-Based AnswerProbiotics reduce the risk of developing antibiotic-associated diarrhea (Strength of Recommendation (SOR) A). (See appendix for the Strength of Recommendation taxomony.)Saccharomyces boulardii and Lactobacillus species have been shown to reduce the risk of antibiotic-associated diarrhea (SOR A).Probiotics should be recommended for the prevention of antibiotic-associated diarrhea (SOR C).However, the duration and dosage for effective treatment have not been established. MethodologyA tertiary review of existing systematic reviews was conducted.PubMed was searched for articles unrestricted by language from inception to 6/11/2013.Terms were searched as text words and included: probiotics, diarrhea, and meta-analysis.Abstracts of the 77 results were reviewed to eliminate any that did not pertain to prevention of antibiotic-associated diarrhea in adults, resulting in 26 articles.The plethora of recent randomized controlled trials and meta-analyses allowed a focus on the five relevant meta-analyses published in the past five years that included at least 10 randomized controlled trials (RCTs) each.[1][2][3][4][5] Data were included on all types of probiotics used in adults (at least 16 years old).The metaanalyses used both inpatient and outpatient settings and defined AAD in various ways.Where meta-analyses included minors or treatment studies, only the subset of data relevant to prevention in adults was examined. Evidence SummaryThe occurrence of AAD ranges from 5 to 30% in outpatient use and has been reported as high as 39% in hospitalized patients, 6 leading to significant healthcare costs due to associated morbidity.AAD is also a reason that many patients are noncompliant with antibiotic use.Therefore, finding a way to reduce AAD has become of increasing interest, particularly with the use of probiotics.Probiotics have been defined as "live microorganisms, which when administered in adequate amounts, confer a health benefit on the host".7 The use of probiotics in * http://www.aafp.org/dam/AAFP/documents/journals/afp/sortdef07.pdf** Patient-oriented evidence measures outcomes that matter to patients: morbidity, mortality, symptom improvement, cost reduction, and quality of life.Disease-oriented evidence measures intermediate, physiologic, or surrogate end points that may or may not reflect improvements in patient outcomes (e.g., blood pressure, blood chemistry, physiologic function, pathologic findings).