Probiotics In Antibiotic-associated Diarrhea Research Articles

From Chaos to Clarity? The Quest for Effective Probiotics in Antibiotic-Associated Diarrhea

Abstract Antibiotic associated diarrhea frequently complicates treatment of infections. A recent randomized, double-blind, placebo-controlled trial tested a proprietary probiotic mixture and found it reduced the incidence of AAD by 16%. This is encouraging for patients, but future progress on probiotics for AAD and other conditions depends on transparency around strain selection, probiotic design guided by preclinical mechanistic studies, and rigorously conducted human studies.

Probiotics for the Prevention of Antibiotic-Associated Diarrhea.

Several communities have started using probiotic-rich fermented foods as therapeutic options with presumed medicinal powers. We now know the importance of microbiome balance and how probiotics can restore imbalances in the microbiome. Probiotics have been tested for a number of clinical uses such as the prevention of antibiotic-associated diarrhea (AAD), the treatment of various diseases such as H. pylori infection, irritable bowel disease, vaginitis, the prevention of allergies, and necrotizing enterocolitis in newborns. AAD has been the most indicated therapeutic use for probiotics. AAD is a common side effect of antibiotic usage, which affects up to 30% of patients. The hypothesis behind using probiotics for AAD is that they help normalize an unbalanced flora. There are many potential mechanisms by which probiotics support intestinal health such as (i) boosting immunity, (ii) increasing gut barrier integrity, (iii) producing antimicrobial substances, (iv) modulating the gut microbiome, (v) increasing water absorption, and (vi) decreasing opportunistic pathogens. Many randomized-controlled trials including the strain-specific trials that use Lactobacillus and Saccharomyces and meta-analyses have shown the benefits of probiotics in addressing AAD. Although adverse events have been reported for probiotics, these are broadly considered to be a safe and inexpensive preventative treatment option for AAD and other gastrointestinal disorders.

Донецкий национальный медицинский университет им. М. Горького, г. Красный Лиман

В статье рассмотрены проблемные вопросы нерационального назначения антибактериальных средств у детей, развития побочных патологических реакций и осложнений, в частности антибиотик­ассоциированных диарей. Представлены современные средства для профилактики и лечения данной категории заболеваний, в частности применение пробиотиков.

Probiotics for Antibiotic-Associated Diarrhea: What, When, and How Long?

Probiotics have been formally defined as “live microorganisms that confer a health benefit on the host when administered in adequate amounts.” Although a range of applications has been explored for probiotics, their utility in antibiotic-associated diarrhea (AAD) is both biologically plausible and supported by abundant clinical evidence. However, the strength of evidence underlying the efficacy of specific strains and formulations for AAD varies widely. This review leverages recent meta-analyses and systematic reviews to clarify some outstanding issues on the utility of probiotics for AAD, including which strains have evidence for efficacy in AAD, what doses have been demonstrated to be effective, and the optimal duration of probiotic therapy, and provides practical guidance on how to select an appropriate product. Some trends emerged in this analysis of recent meta-analyses and systematic reviews, including: 1) Certain probiotics, such as Saccharomyces boulardii and some Lactobacilli-containing products, are consistently found to be effective for the management of AAD; 2) Dosing thresholds for efficacy exist that must be achieved through the administration of probiotics that reliably contain the labeled amounts of probiotic constituents; 3) Most effective probiotics are initiated at the same time as antibiotic therapy and continued for between 1 and 3 weeks after the cessation of therapy. These data suggest that attention must be paid to species, dose, and duration when selecting an appropriate product for patients initiating antibiotic therapy; further considerations may include the antibiotic used and the patient’s baseline risk for AAD.

Probiotics for antibiotic-associated diarrhea: do we have a verdict?

Probiotics use has increased tremendously over the past ten years. This was coupled with a surge of data relating their importance in clinical practice. Antibiotic-associated diarrhea, whose frequency has risen recently, was one of the earliest targets with data published more than ten years ago. Unfortunately, available trials suffer from severe discrepancies associated with variability and heterogeneity of several factors. Most published randomized controlled trials and subsequent meta-analyses suggest benefit for probiotics in the prevention of antibiotic-associated diarrhea. The same seems to also apply when the data is examined for Clostridium difficile-associated colitis. However, the largest randomized double-blind placebo-controlled trial to date examining the use of a certain preparation of probiotics in antibiotic-associated diarrhea showed disappointing results, but it was flawed with several drawbacks. The commonest species of probiotics studied across most trials is Lactobacillus; however, other types have also shown similar benefit. Probiotics have enjoyed an impeccable safety reputation. Despite a few reports of severe infections sometimes leading to septicemia, most of the available trials confirm their harmless behavior and show similar adverse events compared to placebo. Since a consensus dictating its use is still lacking, it would be advisable at this point to suggest prophylactic use of probiotics to certain patients at risk for antibiotic-associated diarrhea or to those who suffered previous episodes.

Probiotics for antibiotic-associated diarrhea

Probiotics for antibiotic-associated diarrhea

Probiotics for antibiotic-associated diarrhea

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Probiotika in der Prävention der Antibiotika-induzierten Diarrhö

Between 5 and 49% of patients treated with antibiotics suffer from diarrhoea. Principally all microbial agents can cause diarrhoea, especially oral agents like cephalosporines, clindamycin, broad-spectrum penicillins, and quinolones of the 3 rd and 4th generation. Manifestations of antibiotic-associated diarrhoea range from mild self-limiting forms to severe life-threatening courses. The potentially most severe form of antibiotic-associated diarrhoea is caused by Clostridium diffcile accounting for approx. 25 % of antibiotic-associated diarrhoea. In the past two decades a broad spectrum of different probiotic strains has been evaluated for the primary prevention of antibiotic-associated diarrhoea in children and adults. Based on their efficacy and clinical data, different levels of evidence and recommendations are emerging on the preventive use of probiotics in antibiotic-associated diarrhoea.

Probiotics for Antibiotic-Associated Diarrhea

Probiotics for Antibiotic-Associated Diarrhea

Meta‐analysis: probiotics in antibiotic‐associated diarrhoea

Diarrhoea is a common occurrence in association with antibiotic administration. Earlier studies and meta-analyses have suggested that probiotic administration reduces the incidence of antibiotic-associated diarrhoea (AAD). To estimate the reduction in risk of AAD with administration of probiotics in randomised placebo-controlled trials and to identify factors associated with such reduction. Meta-analysis of randomised, double-blinded, placebo-controlled trials including patients treated with antibiotics and administered a probiotic for at least the duration of the antibiotic treatment. The outcome was incidence of diarrhoea irrespective of the presence of Clostridium difficile or the development of pseudomembranous colitis. Meta-analysis and meta-regression methods were used to synthesise data and to assess influence of: mean age, duration of antibiotics, risk of bias and incidence of diarrhoea in the placebo group on outcomes. Subgroup analyses explored effects of different probiotic species, patient populations and treatment indications. A total of 34 studies were included with 4138 patients. The pooled relative risk (RR) for AAD in the probiotic group vs. placebo was 0.53 (95% CI 0.44-0.63), corresponding to a number needed to treat (NNT) of 8 (95% CI 7-11). The preventive effect of probiotics remained significant when grouped by probiotic species, population age group, relative duration of antibiotics and probiotics, study risk of bias and probiotic administered. The pooled RR for AAD during treatment for Helicobacter pylori (H. pylori) was 0.37 (95% CI 0.20-0.69), corresponding to a NNT of 5 (95% CI 4-10). This updated meta-analysis confirms earlier results supporting the preventive effects of probiotics in AAD.

Probiotics in Antibiotic-associated Diarrhea: An Updated Meta-analysis of Randomized, Controlled Trials

Probiotics in Antibiotic-associated Diarrhea: An Updated Meta-analysis of Randomized, Controlled Trials

Role of Probiotics in Antibiotic-associated Diarrhea, Clostridium difficile-associated Diarrhea, and Recurrent Clostridium difficile-associated Diarrhea

The role of probiotics in the prevention and treatment of antibiotic-associated diarrhea, Clostridium difficile diarrhea, and recurrent C. difficile diarrhea is reviewed. Various probiotics have variable efficacy. More studies are needed to define further their efficacies, roles, and indications.

Probiotics in antibiotic-associated diarrhoea

Antibiotic-associated diarrhoea is a common event. In some cases, it could represent a life-threatening event. Clostridium difficile colitis is a further distinct complication of antibiotic administration. Treatment options for antibiotic-associated diarrhoea and Clostridium difficile colitis include supplementation with several types of probiotics, as overviewed in this paper. Three randomised, double-blind, controlled clinical trials show a therapeutic effect of Saccharomyces boulardii in antibiotic-associated diarrhoea. The efficacy of Lactobacillus acidophilus and bulgaricus has also been ascertained in two double-blind controlled studies. Other studies focusing on Lactobacillus as a new preventive agent for antibiotic-associated diarrhoea are not double-blind. Among these, a positive effect of Lactobacillus rhamnosus GG, Bifidobacterium longum and Enterococcus faecium SF68 has been reported. Effectiveness of probiotics in antibiotic-associated diarrhoea has, therefore, a consistent scientific rationale, however few studies have performed an assessment of bacterial recovery in stools, and this approach may be helpful in deciding a more rigorous dose standardisation.

Use of probiotics in antibiotic-associated diarrhea: meta-analysis of placebo-controlled trials

Use of probiotics in antibiotic-associated diarrhea: meta-analysis of placebo-controlled trials

The impact of probiotics in antibiotic-associated diarrhea: A meta-analysis of placebo-controlled trials

The impact of probiotics in antibiotic-associated diarrhea: A meta-analysis of placebo-controlled trials

The impact of probiotics in antibiotic-associated diarrhea: A meta-analysis of placebo-controlled trials

The impact of probiotics in antibiotic-associated diarrhea: A meta-analysis of placebo-controlled trials