Comparative efficacy and tolerability of probiotics for antibiotic-associated
diarrhea: Systematic review with network meta-analysis
#MMPMID29511547
Cai J
; Zhao C
; Du Y
; Zhang Y
; Zhao M
; Zhao Q
United European Gastroenterol J
2018[Mar]; 6
(2
): 169-180
PMID29511547
show ga
BACKGROUND: Probiotics are commonly used for the prevention of
antibiotic-associated diarrhea (AAD). However, the optimum regimen remains
controversial. OBJECTIVE: The objective of this article is to compare and rank
the relative efficacy and tolerability among all available probiotic agents for
AAD through a network meta-analysis. METHODS: Eligible studies were identified by
searching PubMed, Embase, Medline, Cochrane library and Web of Science for
randomized controlled trials (RCTs) that examined the efficacy of probiotic
therapy for AAD. A random-effects model was applied within a frequentist
framework. Quality of evidence was performed by the GRADE approach. The project
was prospectively registered with PROSPERO (CRD 42016050776). RESULTS: Fifty-one
articles (60 comparisons, 9569 participants), including 10 probiotic
interventions, were identified. Lactobacillus rhamnosus GG (LGG) had the highest
probability of being ranked best both in effectiveness (odds ratio (OR), 95%
confidence interval (CI) = 0.28 (0.17, 0.47)) and tolerance (0.44 (0.23, 0.84))
on prevention of AAD. With regard to reducing Clostridium difficile infection
rate, Lactobacillus casei (L. casei) was considered better efficacy (0.04 (0.00,
0.77)) and medium tolerance (0.56 (0.19, 1.66)). Strain combination reported no
superiority over single strain in either efficacy or tolerability. CONCLUSIONS:
LGG is probably the best option to consider when AAD is indicated. L. casei
appears to be the most efficacious choice when associated with severe C.
difficile-related cases.
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