Treatment Of Antibiotic-associated Diarrhea Research Articles

The Effectiveness of Synbiotics in Preventing Antibiotic-Associated Diarrhea in Children: A Double-Blind Randomized Clinical Trial

Background: Antibiotic-associated diarrhea (AAD) is of great concern in children due to the wide range of antibiotic administration among this population. Studies considering the use of synbiotics for prevention or treatment of AAD are limited. In the current study, the effectiveness of synbiotics in preventing AAD was investigated. Methods: This randomized, double-blinded clinical trial was conducted on 100 patients undergoing antibiotic therapy for over five days. The patients were randomly divided into a case group receiving synbiotic therapy (Protexin; The United Kingdom) and a control group undergoing placebo therapy (consisting of starch sachets). Both groups began their medication within 24 hours after antibiotic initiation and continued it for further seven days after antibiotic therapy cessation. The two groups were compared regarding the incidence of diarrhea, stool consistency based on the Bristol Stool Scale (BSS), and the duration of diarrhea. Results: The members of case and control groups were not statistically different regarding age, gender distribution, length of hospitalization, the frequency of defecation, and stool consistency based on BSS before antibiotic therapy, primary and final diagnosis, the type of antibiotics prescribed, and duration of antibiotic therapy (P > 0.05). The incidence of AAD was significantly less in the case group compared with the control group (P = 0.016), while those with AAD did not show significant difference regarding the duration of diarrhea, stool consistency based on BSS, and the frequency of defecation a day (P = 0.51, 0.26, and 0.18, respectively). Conclusions: The findings of this study showed that early initiation of synbiotics and its long-term administration following antibiotic therapy cessation could considerably prevent AAD; however, in case of AAD occurrence synbiotic therapy cannot positively affect duration, stool consistency, and the frequency of defecation.

41-Year-Old Man With Fever and Bloody Diarrhea

41-Year-Old Man With Fever and Bloody Diarrhea

Role of Probiotics in Mycoplasma pneumoniae Pneumonia in Children: A Short-Term Pilot Project.

Mycoplasma pneumoniae is one of the most common pathogens causing community-acquired pneumonia in children. Mycoplasma pneumoniae pneumonia (MPP) can be successfully treated with azithromycin; however, antibiotic-associated diarrhea (AAD) is a common adverse effect. Increasing evidence suggests that some probiotics may prevent the development of AAD. The present study determined the effects of probiotics (live Clostridium butyricum plus Bifidobacterium infantis) on the prevention and treatment of AAD in children with MPP when co-administered with intravenous azithromycin. Fifty-five children with MPP were enrolled and received azithromycin (10 mg/kg/day; once daily for 7 days) combined with probiotics (starting on the third day of azithromycin treatment; 1,500 mg three times daily); 50 healthy children served as controls. At the end of the trial, the incidence of AAD, fecal microbiota, intestinal mucosal barriers, and systemic inflammation were analyzed using recommended systems biology techniques. No cases of AAD or other adverse events occurred in children with MPP after co-administration of probiotics with azithromycin. A live C. butyricum plus B. infantis preparation partly reconstructed the gut microbiota, especially restoration of bacterial diversity. The indicators of intestinal mucosal barrier function, such as D-lactate, endotoxin, and diamine oxidase, were significantly improved and the systemic inflammation (interleukin 10) was attenuated after probiotic therapy. The present study indicated that co-administration of probiotics with azithromycin is a promising therapy for MPP treatment which could prevent and treat AAD effectively.

Saccharomyces cerevisiae var. boulardii fungemia following probiotic treatment

Probiotics are commonly prescribed as an adjuvant in the treatment of antibiotic-associated diarrhea caused by Clostridium difficile. We report the case of an immunocompromised 73-year-old patient on chemotherapy who developed Saccharomyces cerevisiae var. boulardii fungemia in a central venous catheter during treatment of antibiotic-associated pseudomembranous colitis with the probiotic Saccharomyces cerevisiae var. boulardii. Fungemia was resolved after interruption of probiotic administration without the need to replace the central venous line.

Meta-analysis of the effects of Bifidobacterium preparations for the prevention and treatment of pediatric antibiotic-associated diarrhea in China

Bifidobacterium preparations are increasingly used for pediatric antibiotic-associated diarrhea (AAD) in China. The aim of this study was to review existing evidence on the efficacy of Bifidobacterium preparations for the prevention and treatment of pediatric AAD in China. Searches were performed with Medline, Embase, Cochrane Central Register of Controlled Trials, CNKI, and CBM databases. Thirty trials met the inclusion criteria. Of the 30 trials, five Bifidobacterium preparations were included. The preparations were all Bifidobacterium based, in combined with Lactobacillus, Enterococcus, Bacillus, Streptococcus or Clostridium strains. The pooled results of the 30 trials, which included 7225 participants, indicated a statistically significant association of Bifidobacterium preparations administration with reduction in pediatric AAD (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.29–0.39; P<0.01). When the meta-analysis was re-performed according to the trials explicitly aiming to prevent or treat pediatric AAD, respectively, the pooled results were similar (Bifidobacterium preparations use for preventing pediatric AAD (n=21): pooled OR, 0.34, 95% CI, 0.28–0.41, P<0.01; Bifidobacterium preparations use for treating pediatric AAD (n=9): pooled OR, 0.32, 95% CI, 0.23–0.43, P<0.01). Subgroup analyses which based on Bifidobacterium preparations variety, clinical condition, or participant’s age also showed statistically significant benefit of adjunct Bifidobacterium preparations for the prevention and treatment of pediatric AAD in China. The pooled evidence suggested that Bifidobacterium preparations might be efficacious for the prevention and treatment of pediatric AAD in China.

Probiotic guidelines and physician practice: a cross-sectional survey and overview of the literature.

Probiotic use by patients and physicians has dramatically increased over the last decade, although definitive evidence is often lacking for their use. We examined probiotic-prescribing practices among health care providers (HCP) at a tertiary medical centre and compared these practices to clinical guidelines. HCP at the Stanford Medical Center received a survey on probiotic prescribing practices including choice of probiotic and primary indications. A broad overview of the literature was performed. Among 2,331 HCP surveyed, 632 responded. Of the 582 of these who routinely prescribed medications, 61% had recommended probiotic foods or supplements to their patients. Women and gastroenterologists were more likely to prescribe probiotics (odds ratio (OR): 1.5, 95% confidence interval (CI): 1.0-2.1; OR: 3.9, 95% CI: 1.5-10.1, respectively). Among probiotic prescribers, 50% prescribed inconsistently or upon patient request, and 40% left probiotic choice to the patient. Common indications for probiotics, particularly Lactobacillus GG, were prevention and treatment of antibiotic-associated diarrhoea (79 and 66%, respectively). Probiotics were often prescribed for 'general bowel health' or at patient request (27 and 39% of responders, respectively). Most respondents (63%) thought an electronic medical record (EMR) pop-up would change probiotic prescribing patterns. However, a review of published guidelines and large trials found inconsistencies in probiotic indications, dosages and strain selection. Probiotic prescribing is common but lacks consistency, with choice of probiotic frequently left to the patient, even for indications with some strain-specific evidence. Implementation of EMR pop-ups/pocket guides may increase consistency in probiotic prescribing, although the lack of clear and consistent guidelines must first be addressed with large, well-designed clinical trials.

Structural modulation of gut microbiota during alleviation of antibiotic-associated diarrhea with herbal formula

The gut microbiome is hypothesized to play a critical role in gastrointestinal diseases, including antibiotic-associated diarrhea (AAD). To determine whether the traditional Chinese herbal formula of Shen Ling Bai Zhu San (SLBZS) modulates the composition of the gut microbiome during AAD treatment, an AAD diarrhea model was prepared in rats by gastric gavage with lincomycin for 7 successive days, followed by administration of SLBZS for one week. At all time points after the SLBZS treatment, the diarrhea rates were significantly or at least numerically lower than that of the untreated model group. Overall structural modulation of the gut microbiome occurred after SLBZS treatment, with reverting effects on the AAD-induced structural variations. At the genus level, the relative abundance of Sutterella was negatively correlated with SLBZS treatment and positively correlated with a lack of treatment, suggesting that Sutterella might be a pivotal phylotype associated with the improvement of AAD. The key phylotypes of the gut microbiome that responded to SLBZS indicated enrichment of beneficial bacteria, and particularly Bacteroides spp. These data therefore demonstrated that structural changes of the gut microbiome are induced by the Chinese herbal formula SLBZS. In conclusion, changes in the gut microbiome are associated with the diarrhea-controlling effect of SLBZS.

THE CLINICAL POTENTIAL OF LINEX FORTE® IN SYSTEMIC ANTIBIOTIC THERAPY

The article tells about the prevalence and etiopathogenesis of antibiotic-associated diarrhea and the main pathogens focusing on Clostridium difficile. The methods of treatment of the disease are described. The article is largely an overview of research reports on the use of probiotics for the prevention and treatment of antibiotic-associated diarrhea. In accordance with the declared topic, the author’s original study of the probiotic complex Linex® Forte is presented.

Effect of intestinal microbiome in norm and pathology on human health

The intestinal microbiome plays a significant role in the regulation of peristalsis, exerts some influence on the functioning of the immune system, course of metabolic processes and formation of some aspects of behavior. There is evidence that maternal microflora can exert an influence on the fetus by translocation of bacteria or bacterial particles through the placental barrier, although, of course, the main colonization of the intestine of the infant occurs in the process of natural childbirth under the influence of the vaginal and intestinal flora of the mother. In children born by cesarean section the normal colonization of the gut is disturbed, which can determine a higher risk of developing in the future of some immune-mediated diseases, Type 1 diabetes mellitus and obesity. Medical men often try to adjust dysbiosis or changes in the composition of the fecal microflora called dysbiosis by the use of probiotics. In addition to the well-known effects of probiotics in the treatment of acute diarrhea in children, these drugs currently are being increasingly used for prevention of necrotizing enterocolitis of the newborn, despite the fact that evidence of the effectiveness of their routine use is not sufficient. A number of studies have shown that some probiotics may be effective in the prevention of atopic diseases, prevention and treatment of antibiotic-associated diarrhea, reducing the frequency and severity of necrotizing enterocolitis, relief of infant colic, and therapy of constipation. Given the role of microbiota in the development of obesity, some probiotics have been used and showed their effectiveness in weight loss. The fecal microflora transplantation was introduced relatively recently to treat Clostridium difficile infection and inflammatory bowel disease. In this review we discuss current data on the intestinal microbiota, its formation, functions, disturbance of the composition and possible ways of their correction.

Antibiotic-associated diarrhea in children: a current view of the problem

Antibiotic-associated diarrhea (AAD) is a common and quite dangerous complication of antibiotic therapy. AAD treatment is associated with certain challenges; the disease can be recurrent, while hospitalized patients can pose an epidemiological risk. The article tells about the etiology and pathogenesis of AAD, the main approaches in the diagnosis and treatment. The use of modern probiotic drugs against a background of antibacterial therapy seems effective in preventing AAD. The article demonstrates that Linex® Forte is one of the most efficient drugs for the treatment and prevention of the disease.

Probiotic Guidelines and Physician Practice: A Cross-Sectional Survey

Introduction: Probiotic use has dramatically increased over the last decade, though formal guidelines and robust clinical trials are lacking. Our study examined probiotic prescribing practices among providers at a tertiary medical center. Methods: An electronic survey was sent to 2331 health care providers (HCP) at a tertiary medical center with questions regarding probiotic prescribing practices. A review of the literature was performed.Table 2: Summary of guidelines, Cochrane reviews, and large meta-analyses (n>500) investigating probiotic use for specific indicationsResults: A total of 632 HCP (27%) completed the survey, of whom 582 routinely prescribed medications of any kind (Table 1). Most (61%) had recommended probiotics to their patients, including both foods and supplements. After adjustment for covariates, female HCP were more likely to prescribe probiotics than male (OR 1.5 [95% CI 1.0-2.1]). Gastroenterologists were also more likely to prescribe probiotics than other HCP (OR 3.9 [95% CI 1.5-10.1]) and more likely to give a specific strain recommendation (OR 4.2 [95% CI 1.4-12.5]). Among probiotic prescribers, 49% said they prescribed them inconsistently or only upon patient request, and 40% left probiotic choice to the patient. The most common indications for probiotics were prevention and treatment of antibiotic-associated diarrhea (AAD)(79% and 66% of prescribers, respectively), with Lactobacillus GG (LGG) being most commonly used. Probiotics, especially Lactobacillus spp., were often prescribed for “general bowel health” and at patient request (by 16% and 23% of responders, respectively). For preventing AAD, 64% left probiotic choice to the patient and 11% prescribed L. acidophilus, despite strong evidence for LGG and S. boulardii.Table 1: Characteristics of survey respondents.Among gastroenterologists (n=33), leading indications were IBS (70%, primarily probiotic mixtures and Bifidobacteria), patient request (48%), IBD (45%), and reduction of infant colic (27%, mostly L. reuteri). Among all HCP, perceived barriers to probiotic use included safety and monitoring concerns, lack of clear guidelines and evidence in certain patient populations, non-acceptance by colleagues, and unfamiliarity with current evidence. Fifty-six percent of respondents thought an EMR pop-up would change their probiotic prescribing pattern. Conclusion: Probiotic prescribing is common, particularly among gastroenterologists and female HCP, but is inconsistent, with the choice of probiotic frequently being left to the patient. For evidence-based indications, implementation of EMR pop-ups or pocket guides may be helpful to increase consistency in probiotic-prescribing.

Probiotics Reduce the Risk of Antibiotic-Associated Diarrhea in Adults (18-64 Years) but Not the Elderly (>65 Years): A Meta-Analysis.

Antibiotic-associated diarrhea (AAD) is a common problem in adults and elderly patients due to the widespread use of antibiotics in this population. Multiple previous systematic reviews have demonstrated an association between specific probiotics and decrease of AAD, especially in children. As there is no specific analysis concerning the elderly patients, we decided to focus on adults, especially elderly people. We performed a systematic review of the literature regarding the use of probiotics in the treatment of AAD in adults (18-64 years old) and elderly subjects (≥65 years old). We identified 436 articles that met the search criteria. Thirty randomized controlled trials met the predefined inclusion criteria and were included in the meta-analysis. There was considerable heterogeneity among the trials (P < .001); thus, subgroup analyses were performed. The meta-analysis resulted in a pooled relative risk (RR) of AAD of 0.69 (95% confidence interval [95% CI]: 0.62-0.76) in a fixed effects model and 0.58 (95% CI: 0.48-0.71) in a random effects model, as compared with placebo. The positive association between intake of probiotic and reduced risk of AAD was observed in adults (RR, 0.47; 95% CI: 0.4-0.56). In contrast, in elderly patients, there was no positive effect (RR, 0.94; 95% CI: 0.76-1.15) of probiotic use and AAD. In summary, the results emerging from our meta-analysis suggested that adjunct probiotic administration is associated with a reduced risk of AAD in adults but not in elderly people.

Probiotics in critically ill children.

Gut microflora contribute greatly to immune and nutritive functions and act as a physical barrier against pathogenic organisms across the gut mucosa. Critical illness disrupts the balance between host and gut microflora, facilitating colonization, overgrowth, and translocation of pathogens and microbial products across intestinal mucosal barrier and causing systemic inflammatory response syndrome and sepsis. Commonly used probiotics, which have been developed from organisms that form gut microbiota, singly or in combination, can restore gut microflora and offer the benefits similar to those offered by normal gut flora, namely immune enhancement, improved barrier function of the gastrointestinal tract (GIT), and prevention of bacterial translocation. Enteral supplementation of probiotic strains containing either Lactobacillus alone or in combination with Bifidobacterium reduced the incidence and severity of necrotizing enterocolitis and all-cause mortality in preterm infants. Orally administered Lactobacillus casei subspecies rhamnosus, Lactobacillus reuteri, and Lactobacillus rhamnosus were effective in the prevention of late-onset sepsis and GIT colonization by Candida in preterm very low birth weight infants. In critically ill children, probiotics are effective in the prevention and treatment of antibiotic-associated diarrhea. Oral administration of a mix of probiotics for 1 week to children on broad-spectrum antibiotics in a pediatric intensive care unit decreased GIT colonization by Candida, led to a 50% reduction in candiduria, and showed a trend toward decreased incidence of candidemia. However, routine use of probiotics cannot be supported on the basis of current scientific evidence. Safety of probiotics is also a concern; rarely, probiotics may cause bacteremia, fungemia, and sepsis in immunocompromised critically ill children. More studies are needed to answer questions on the effectiveness of a mix versus single-strain probiotics, optimum dosage regimens and duration of treatment, cost effectiveness, and risk-benefit potential for the prevention and treatment of various critical illnesses.

Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Children.

This article provides recommendations, developed by the Working Group (WG) on Probiotics of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition, for the use of probiotics for the prevention of antibiotic-associated diarrhea (AAD) in children based on a systematic review of previously completed systematic reviews and of randomized controlled trials published subsequently to these reviews. The use of probiotics for the treatment of AAD is not covered. The recommendations were formulated only if at least 2 randomized controlled trials that used a given probiotic (with strain specification) were available. The quality of evidence (QoE) was assessed using the Grading of Recommendations Assessment, Development, and Evaluation guidelines. If the use of probiotics for preventing AAD is considered because of the existence of risk factors such as class of antibiotic(s), duration of antibiotic treatment, age, need for hospitalization, comorbidities, or previous episodes of AAD diarrhea, the WG recommends using Lactobacillus rhamnosus GG (moderate QoE, strong recommendation) or Saccharomyces boulardii (moderate QoE, strong recommendation). If the use of probiotics for preventing Clostridium difficile-associated diarrhea is considered, the WG suggests using S boulardii (low QoE, conditional recommendation). Other strains or combinations of strains have been tested, but sufficient evidence is still lacking.

Antibiotic-associated diarrhoea in emergency department observation unit patients.

Clostridium difficile diarrhoea is an urgent threat to patients, but little is known about the role of antibiotic administration that starts in emergency department observation units (EDOUs). We studied risk factors for antibiotic-associated diarrhoea (AAD) and C. difficile infection (CDI) in EDOU patients. This prospective cohort study enrolled adult patients discharged after EDOU antibiotic treatment between January 2013 and 2014. We obtained medical histories, EDOU treatment and occurrence of AAD and CDI over 28 days after discharge. We enrolled and followed 275 patients treated with antibiotics in the EDOU. We found that 52 (18·6%) developed AAD and four (1·5%) had CDI. Patients treated with vancomycin [relative risk (RR) 0·52, 95% confidence interval (CI) 0·3-0·9] were less likely to develop AAD. History of developing diarrhoea with antibiotics (RR 3·11, 95% CI 1·92-5·03) and currently failing antibiotics (RR 1·90, 95% CI 1·14-3·16) were also predictors of AAD. Patients with CDI were likely to be treated with clindamycin. In conclusion, AAD occurred in almost 20% of EDOU patients with risk factors including a previous history of diarrhoea with antibiotics and prior antibiotic therapy, while the risk of AAD was lower in patients receiving treatment regimens utilizing intravenous vancomycin.

Successful treatment of antibiotic-associated diarrhea with a herbal medicine, daiobotampito

Case We present the case of a 43-year-old woman diagnosed with antibiotic-associated diarrhea. She had diarrheal and hemorrhagic stool after secondary eradication of Helicobacter pylori. On examination of feces, rapid test for Clostridium difficile was glutamate dehydrogenase (GDH) antigen positive/toxins negative. Vancomycin was initiated for the C. difficile infection due to intolerance (nausea) of metronidazole, but vancomycin treatment was a clinical failure. GDH screening test continued to be positive. Kampo treatment was requested and daiobotampito (DBT) was selected due to eligible right lower quadrant abdominal pain. Stool abnormality improved and the GDH test became negative after DBT treatment. Outcome Symptoms such as diarrheal and hemorrhagic stool improved after treatment with DBT. Conclusion DBT may be useful for antibiotic-associated diarrhea non-responsive to antibiotics.

A clinical reading on “World Allergy Organization-McMaster University Guidelines for Allergic Disease Prevention (GLAD-P): Probiotics”

To the Editor Since the immunomodulatory properties of probiotics have been described, the effect of probiotic supplementation has been investigated in several trials and it has been also proposed as a preventive intervention for the development of allergic diseases. Recently two important evidence-based recommendations about the use of probiotics in the prevention of allergy were published [1, 2] with conflicting conclusions, in particular the most recent guideline [1] seems to be partially in contradiction with the previous statements about prevention of eczema. For these reasons, we tried to analyze the evidences leading to these recommendations [1] to highlight the aspects that can be more directly related or correlated with clinical practice. This clinical reading was addressed to offer some reflections about the methods used to formulate such recommendations, and the possibility to adopt in the clinical practice the proposed conclusions. We tried to retraces the path proposed by the Authors to analyse three important questions about the efficacy of probiotics in preventing allergic diseases if administrated to pregnant women (first question), to breastfeeding mothers (second question) and in healthy infants (third question). These questions have been investigated by using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach [3], to perform a systematic review of randomized controlled trials and formulate recommendations. In summary, the GRADE method aims to define a rigorous and explicit method for the production of clinical recommendations. According to this method, the knowledge of advantages and disadvantages, benefits and risks of an intervention is necessary to make decisions in the health field. The GRADE approach also provides a three-phases decisional framework: a) formulation of a clinical question, with the choice and the formal evaluation of its related outcomes, and systematic evaluation of the scientific literature and the quality of the evidence; b) evaluation of the benefits and risks associated to the intervention, taking also in consideration its feasibility, the necessary resources and the patients’ preferences; c) formal definition of the strength of the recommendation. From a methodological point of view, it should be noted that the recommendations are directed to patients, clinicians and other health care professionals with different objectives, as clearly explained in the guidelines introduction. Each recommendation can have different levels of strength: strong recommendation indicates that patients would like to receive the intervention and that clinicians should actuate it. Conditional or weak recommendation indicates that the majority of patients would like to receive the intervention, but many other not, as well as they hope that clinicians would recognize that different choices may be appropriate for different patients, by taking advantage of decision-making tools to help patients to make consistent choices. In the results section of the guidelines we can read that “Currently available evidence does not indicate that probiotic supplementation reduces the risk of developing * Correspondence: giampaolo.ricci@unibo.it Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, S. Orsola-Malpighi Hospital, Pad 16, via Massarenti 11, 40138 Bologna, Italy Full list of author information is available at the end of the article

Antibiotics Usage and Intestinal Microbiota

Since the discovery of penicillin, antibiotics have made significant contributions to the treatment of infections in humans. However, as antibiotics are effective not only against pathogenic bacteria but also against all bacterial species that comprise the normal microbiota within the intestine, they can disrupt the balance in the composition of the intestinal microbiota, which causes antibiotic-associated diarrhea (AAD). In particular, infections caused by Clostridium difficile , a pathogenic bacterium known to cause AAD, can lead to pseudomembranous colitis or, in severe cases, death. AAD is primarily treated by halting the administration of the antibiotic thought to be causing the symptoms. After a diagnosis of C. difficile infection is confirmed, if symptoms persist and the patient's condition worsens despite ceasing the administration of the causative antibiotic, the administration of metronidazole or vancomycin may be considered. Moreover, several probiotics have been considered effective in the prevention and treatment of AAD.

Prophylaxis and treatment of antibiotic-associated diarrhea: is there evidence for using probiotics?

A 66-year-old woman with a history of liver cirrhosis and alcohol abuse presented with hematemesis and black tarry stools secondary to a variceal bleed. The patient was started on ceftriaxone for prophylaxis of spontaneous bacterial peritonitis and subsequently developed Clostridium difficile negative antibioticassociated diarrhea (AAD). Are probiotics an appropriate adjunct to therapeutic regimens for AAD and could prophylactic use of probiotics have prevented this complication?

OC-034 Probiotics for the prevention of antibiotic associated diarrhoea in the older inpatient population; a systematic review and meta-analysis

Introduction Probiotics are live microorganisms intended to confer a health benefit when consumed, 1 and have been advocated for the prevention of antibiotic associated diarrhoea (AAD). Older patients are more susceptible to AAD compared to the general adult population. We conducted a systematic review and meta-analysis of the literature on probiotic use for the prevention of AAD in this patient group. Method Two independent reviewers identified and critically appraised randomised controlled trials (RCTs) of probiotics from electronic databases PubMed and EMBASE (from date of inception to Jan 2015) for the prevention and treatment of AAD in hospital patients with mean age >60 years. Results Eleven RCTs met inclusion criteria. The pooled relative risk (RR) in a DerSimonian-Laird random-effects meta-analysis of 11 RCTs, which included 4292 participants, showed a reduction in AAD (RR 0.67, 95% confidence interval (CI), 0.48 to 0.95; p = 0.02; I 2 = 64%). Subgroup genus analysis demonstrated a significant risk reduction with only Lactobacillus based probiotics (RR 0.51, CI 0.39 to 0.67, p I 2 = 0%). Only 3/11 demonstrated adequate power. Adverse events were reported in only 6/11 RCTs, with no serious events attributed to probiotic use. Conclusion Pooled results demonstrate that probiotics are associated with a risk reduction in AAD in older inpatients. Subgroup analysis demonstrated that this benefit is derived from Lactobacillus-only probiotics, an attractive candidate for future research. Disclosure of interest None Declared. Reference FAO, WHO. Health and nutritional properties of probiotics in food including powder milk with live lactic acid bacteria. 2001. ftp://ftp.fao.org/ed/esn/food/probio_report_en.pdf