Probiotics for the prevention of antibiotic-associated diarrhea – an umbrella review of meta-analyses of randomized controlled trials

E Lyn Lee
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Sulfath Thekkumcheril Sidhick
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Mari Kannan Maharajan
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Suresh Shanmugham
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Pravinkumar Vishwanath Ingle
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Suresh Kumar
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Siew Mooi Ching
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Yeong Yeh Lee
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Sajesh K. Veettil
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School of Pharmacy, IMU University, Kuala Lumpur, Malaysia
Department of Community Medicine, Jubilee Mission Medical College, Thrissur, India
School of Pharmacy, University of Nottingham Malaysia, Malaysia
School of Pharmacy, IMU University, Kuala Lumpur, Malaysia
Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
School of Pharmacy, IMU University, Kuala Lumpur, Malaysia
Department of Family Medicine, Faculty of Medicine and Health Sciences, University Putra Malaysia, Malaysia
School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
School of Pharmacy, IMU University, Kuala Lumpur, Malaysia
Received: 23 July 2024 / Revised: 3 October 2024 / Accepted: 8 October 2024 / Published: 30 March 2025

Abstract

Introduction and aim. Antibiotic therapies induce diarrhea by disrupting the intestinal microbiota, prompting research into probiotics to prevent antibiotic-associated diarrhea (AAD). The aim of this study was to systematically identify and summarize meta-analyses of randomized controlled trials (RCT) on probiotics for AAD prevention.

Material and methods. Databases including PubMed, EMBASE, Epistemonikos, and the Cochrane Database were searched up to December 11, 2023. Systematic reviews and meta-analyses of RCTs on probiotics for AAD prevention in any age group were included. Meta-analyses were re-performed to calculate pooled risk ratios (RR) with 95% confidence intervals (CI). Evidence quality was assessed using GRADE criteria.

Analysis of the literature. The review included 16 articles with 39 unique meta-analyses. Probiotics reduced AAD risk across various groups: adults (RR 0.47, 95% CI 0.40–0.56), all ages (RR 0.58, 95% CI 0.50–0.68), and outpatients (RR 0.49, 95% CI 0.36 0.66) with a moderate level of evidence. For the use of any probiotics in pediatrics, the initial high-quality evidence (RR 0.48, 95% CI 0.44–0.63) was downgraded to moderate after a sensitivity analysis excluding small studies.

Conclusion. Probiotics are beneficial in preventing AAD, but evidence quality varies from low to moderate. High-quality trials are needed to identify the most effective probiotic species and strains, dosages, and target patient populations.

 

Cite 

Lee EL, Sidhick ST, Maharajan MK, Shanmugham S, Ingle PV, Kumar S, Ching SM, Lee YY, Veettil SK. Probiotics for the preven tion of antibiotic-associated diarrhea – an umbrella review of meta-analyses of randomized controlled trials. Eur J Clin Exp Med. 2025;23(1):237–244. doi: 10.15584/ejcem.2025.1.22.

 

Supplementary

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