Probiotics for the Prevention of Antibiotic-associated Diarrhea in Aged People: A Meta-analysis_West China Medical Journal

Authors：

 PUFang-fang ^1,2 , LIXue-mei ^1,2 , WANGYa-juan ^1,2 , SHILei ² , LIJing-jing ¹ ,  HUWen ^1,2

1. West China School of Public Health;Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Clinical Nutrition, West China Hospital;Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

HUWen, Email: wendyhu67@21cn.com

Keywords：

Probiotics; Antibiotic-associated diarrhea; Elderly; Meta-analysis

DOI：

10.7507/1002-0179.20150257

Video：

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Objective To systematically evaluate the efficacy of probiotics in preventing antibiotic-associated diarrhea (AAD) in aged people. Methods PubMed, Web of Science, the Cochrane Database of Systematic Reviews, the Cochrane Controlled Trials Register, CNKI, VIP, and WANFANG electronic databases were searched for studies published, and references of included studies and reviews were screened from database inception to April 2014. Only randomized, controlled trials involving patients older than 65 years were included. Furthermore, only the trials which combined antibiotic administration and probiotic therapy for the prevention of AAD and Jadad score >3 were extracted. Results A total of eight articles containing 3 680 subjects (1 843 in the probiotic group, 1 837 people in the control group) met the inclusion criteria. Meta-analysis showed that there was no significant difference in the risk of antibiotic-associated diarrhea (AAD) between probiotics and control groups[RR=0.76, 95%CI (0.51, 1.13), P=0.17]. Further subgroup analysis found that compared with the control group, saccharomyces[RR=1.24, 95%CI (0.70, 2.19), P=0.46], lactobacillus[RR=0.59, 95%CI (0.31, 1.13), P=0.11], multi-probiotics combination[RR=0.58, 95%CI (0.24, 1.41), P=0.23] in the probiotics group were not significantly different. Conclusion There is no evidence to support that probiotics can reduce the risk of AAD among aged people administrated with antibiotics therapy.

Citation： PUFang-fang, LIXue-mei, WANGYa-juan, SHILei, LIJing-jing, HUWen. Probiotics for the Prevention of Antibiotic-associated Diarrhea in Aged People: A Meta-analysis. West China Medical Journal, 2015, 30(5): 899-904. doi: 10.7507/1002-0179.20150257 Copy

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7.	Cremonini F, Di Caro S, Santarelli L, et al. Probiotics in antibiotic-associated diarrhoea[J]. Dig Liver Dis, 2002, 34(Suppl 2):S78-S80.
8.	Rolfe RD. The role of probiotic cultures in the control of gastrointestinal health[J]. J Nutr, 2000, 130(Suppl 2):396S-402S.
9.	Gratz SW, Mykkanen H, El-Nezami HS. Probiotics and gut health:a special focus on liver diseases[J]. World J Gastroenterol, 2010, 16(4):403-410.
10.	Johnston BC, Goldenberg JZ, Vandvik PO, et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea[J]. Cochrane Database Syst Rev, 2011(11):CD004827.
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13.	Beausoleil M, Fortier N, Guénette S, et al. Effect of a fermented milk combining Lactobacillus acidophilus Cl1285 and Lactobacillus casei in the prevention of antibiotic-associated diarrhea:a randomized, double-blind, placebo-controlled trial[J]. Can J Gastroenterol, 2007, 21(11):732-736.
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15.	Wright K, Wright H, Murray M. Probiotic treatment for the prevention of antibiotic-associated diarrhoea in geriatric patients:a multicentre randomised controlled pilot study[J/OL]. Australas J Ageing, 2014. doi:10.1111/ajag.12116.
16.	Pozzoni P, Riva A, Bellatorre AG, et al. Saccharomyces boulardii for the prevention of antibiotic-associated diarrhea in adult hospitalized patients:a single-center, randomized, double-blind, placebo-controlled trial[J]. Am J Gastroenterol, 2012, 107(6):922-931.
17.	Hartling L, Ospina M, Liang YY, et al. Risk of bias versus quality assessment of randomised controlled trials:cross sectional study[J]. BMJ, 2009, 339:b4012.
18.	Lewis SJ, Potts LF, Barry RE. The lack of therapeutic effect of Saccharomyces boulardii in the prevention of antibiotic-related diarrhoea in elderly patients[J]. J Infect, 1998, 36(2):171-174.
19.	Plummer S, Weaver MA, Harris JC, et al. Clostridium difficile pilot study:effects of probiotic supplementation on the incidence of C. difficile diarrhoea[J]. Int Microbiol, 2004, 7(1):59-62.
20.	Safdar N, Barigala R, Said A, et al. Feasibility and tolerability of probiotics for prevention of antibiotic-associated diarrhoea in hospitalized US military veterans[J]. J Clin Pharm Ther, 2008, 33(6):663-668.
21.	Hébuterne X. Gut changes attributed to ageing:effects on intestinal microflora[J]. Curr Opin Clin Nutr Metab Care, 2003, 6(1):49-54.
22.	Hopkins MJ, Sharp R, Macfarlane GT. Age and disease related changes in intestinal bacterial populations assessed by cell culture, 16S rRNA abundance, and community cellular fatty acid profiles[J]. Gut, 2001, 48(2):198-205.
23.	Hopkins MJ, Macfarlane GT. Changes in predominant bacterial populations in human faeces with age and with Clostridium difficile infection[J]. J Med Microbiol, 2002, 51(5):448-454.
24.	McFarland LV. Epidemiology of infectious and iatrogenic nosocomial diarrhea in a cohort of general medicine patients[J]. Am J Infect Control, 1995, 23(5):295-305.
25.	Johnston BC, Goldenberg JZ, Vandvik PO, et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea[J]. Cochrane Database Syst Rev, 2007(2):CD004827.
26.	Szajewska H, Ruszczyński M, Radzikowski A. Probiotics in the prevention of antibiotic-associated diarrhea in children:a meta-analysis of randomized controlled trials[J]. J Pediatr, 2006, 149(3):367-372.
27.	Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea:a systematic review and meta-analysis[J]. JAMA, 2012, 307(18):1959-1969.

1. Bartlett JG. Antibiotic-associated diarrhea[J]. N Engl J Med, 2002, 346(5):334-339.
2. Mcfarland LV. Epidemiology, risk factors and treatments for antibiotic-associated diarrhea[J]. Digest Dis, 1998, 16(5):292-307.
3. Yin X, Song FJ, Gong YH, et al. A systematic review of antibiotic utilization in China[J]. J Antimicrob Chemother, 2013, 68(11):2445-2452.
4. Currie J, Lin WC, Zhang W. Patient knowledge and antibiotic abuse:evidence from an audit study in China[J]. J Health Econ, 2011, 30(5):933-949.
5. Levy J. The effects of antibiotic use on gastrointestinal function[J]. Am J Gastroenterol, 2000, 95(Suppl 1):S8-S10.
6. Salminen S. Human studies on probiotics:aspects of scientific documentation[J]. Scand J Nutr, 2001, 45(1):8-12.
7. Cremonini F, Di Caro S, Santarelli L, et al. Probiotics in antibiotic-associated diarrhoea[J]. Dig Liver Dis, 2002, 34(Suppl 2):S78-S80.
8. Rolfe RD. The role of probiotic cultures in the control of gastrointestinal health[J]. J Nutr, 2000, 130(Suppl 2):396S-402S.
9. Gratz SW, Mykkanen H, El-Nezami HS. Probiotics and gut health:a special focus on liver diseases[J]. World J Gastroenterol, 2010, 16(4):403-410.
10. Johnston BC, Goldenberg JZ, Vandvik PO, et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea[J]. Cochrane Database Syst Rev, 2011(11):CD004827.
11. Avadhani A, Miley H. Probiotics for prevention of antibiotic-associated diarrhea and clostridium difficile-associated disease in hospitalized adults. A meta-analysis[J]. J Am Acad Nurse Pract, 2011, 23(6):269-274.
12. Hickson M, D'souza AL, Muthu N, et al. Use of probiotic Lactobacillus preparation to prevent diarrhoea associated with antibiotics:randomised double blind placebo controlled trial[J]. BMJ, 2007, 335(7610):80-83.
13. Beausoleil M, Fortier N, Guénette S, et al. Effect of a fermented milk combining Lactobacillus acidophilus Cl1285 and Lactobacillus casei in the prevention of antibiotic-associated diarrhea:a randomized, double-blind, placebo-controlled trial[J]. Can J Gastroenterol, 2007, 21(11):732-736.
14. Allen SJ, Wareham K, Wang D, et al. A high-dose preparation of lactobacilli and bifidobacteria in the prevention of antibiotic-associated and Clostridium difficile diarrhoea in older people admitted to hospital:a multicentre, randomised, double-blind, placebo-controlled, parallel arm trial (PLACIDE)[J]. Health Technol Assess, 2013, 17(57):1-140.
15. Wright K, Wright H, Murray M. Probiotic treatment for the prevention of antibiotic-associated diarrhoea in geriatric patients:a multicentre randomised controlled pilot study[J/OL]. Australas J Ageing, 2014. doi:10.1111/ajag.12116.
16. Pozzoni P, Riva A, Bellatorre AG, et al. Saccharomyces boulardii for the prevention of antibiotic-associated diarrhea in adult hospitalized patients:a single-center, randomized, double-blind, placebo-controlled trial[J]. Am J Gastroenterol, 2012, 107(6):922-931.
17. Hartling L, Ospina M, Liang YY, et al. Risk of bias versus quality assessment of randomised controlled trials:cross sectional study[J]. BMJ, 2009, 339:b4012.
18. Lewis SJ, Potts LF, Barry RE. The lack of therapeutic effect of Saccharomyces boulardii in the prevention of antibiotic-related diarrhoea in elderly patients[J]. J Infect, 1998, 36(2):171-174.
19. Plummer S, Weaver MA, Harris JC, et al. Clostridium difficile pilot study:effects of probiotic supplementation on the incidence of C. difficile diarrhoea[J]. Int Microbiol, 2004, 7(1):59-62.
20. Safdar N, Barigala R, Said A, et al. Feasibility and tolerability of probiotics for prevention of antibiotic-associated diarrhoea in hospitalized US military veterans[J]. J Clin Pharm Ther, 2008, 33(6):663-668.
21. Hébuterne X. Gut changes attributed to ageing:effects on intestinal microflora[J]. Curr Opin Clin Nutr Metab Care, 2003, 6(1):49-54.
22. Hopkins MJ, Sharp R, Macfarlane GT. Age and disease related changes in intestinal bacterial populations assessed by cell culture, 16S rRNA abundance, and community cellular fatty acid profiles[J]. Gut, 2001, 48(2):198-205.
23. Hopkins MJ, Macfarlane GT. Changes in predominant bacterial populations in human faeces with age and with Clostridium difficile infection[J]. J Med Microbiol, 2002, 51(5):448-454.
24. McFarland LV. Epidemiology of infectious and iatrogenic nosocomial diarrhea in a cohort of general medicine patients[J]. Am J Infect Control, 1995, 23(5):295-305.
25. Johnston BC, Goldenberg JZ, Vandvik PO, et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea[J]. Cochrane Database Syst Rev, 2007(2):CD004827.
26. Szajewska H, Ruszczyński M, Radzikowski A. Probiotics in the prevention of antibiotic-associated diarrhea in children:a meta-analysis of randomized controlled trials[J]. J Pediatr, 2006, 149(3):367-372.
27. Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea:a systematic review and meta-analysis[J]. JAMA, 2012, 307(18):1959-1969.

West China Medical Journal

Probiotics for the Prevention of Antibiotic-associated Diarrhea in Aged People: A Meta-analysis

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