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Probiotics for Prevention of Antibiotic-associated Diarrhea

Doron, Shira Idit MD*; Hibberd, Patricia L. MD, PhD* †; Gorbach, Sherwood L. MD* ‡

Journal of Clinical Gastroenterology: July 2008 - Volume 42 - Issue - p S58-S63
doi: 10.1097/MCG.0b013e3181618ab7

Antibiotic-associated diarrhea (AAD) occurs in approximately 25% of patients receiving antibiotics. Hospitalized patients with AAD are at increased risk for nosocomial infections and have a higher mortality. Probiotics are living microorganisms used to restore gut health by changing the intestinal microbiota. Several have been studied for the prevention of AAD. Five meta-analyses of trials of probiotics for the prevention of AAD have been performed. The results showed an overall reduction in the risk of AAD when probiotics were coadministered with antibiotics. McFarland conducted the largest meta-analysis to date analyzing 25 randomized controlled trials of probiotics for the prevention of AAD including 2810 subjects. More than half of the trials demonstrated efficacy of the probiotic. In particular, Lactobacillus GG, Saccharomyces boulardii, and the probiotic mixtures were effective. The Cochrane Database of Systematic Reviews published a review of the literature on the use of probiotics for the prevention of pediatric AAD, including 10 randomized trials testing 1986 children. The per protocol pooled analysis, but not the intent-to-treat analysis, showed that probiotics are effective for preventing AAD with the number needed to treat to prevent 1 case of diarrhea being 10. Lactobacillus GG, Bacillus coagulans, and S. boulardii appeared to be most effective. Probiotics are generally safe, however, they should be used with caution in patients who have compromise of either the immune system or the integrity of the intestinal mucosa, and in the presence of a central venous catheter.

*Division of Geographic Medicine and Infectious Diseases, Tufts-New England Medical Center

Center for Global Health Research

Division of Nutrition and Infection, Tufts University School of Medicine, Boston, MA

Dr Gorbach held a patent on Lactobacillus GG which expired in 2006 and he has no present financial interests.

Dr Hibberd receives grant support from Amerifit Brands, Inc.

Partial support provided by NIH Grant K24AT003683.

Reprints: Shira Idit Doron, MD, 750 Washington St, NEMC No. 238, Boston, MA 02111 (e-mail:

Received for publication October 25, 2007; accepted November 7, 2007

© 2008 Lippincott Williams & Wilkins, Inc.