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Antibiotic treatment may disturb the resistance of gastrointestinal flora to colonization. This may result in complications, the most serious of which is Clostridium difficile–associated diarrhea (CDAD). Dr Bradley Johnston and colleagues from Canada assessed the efficacy and safety of probiotics for the prevention of CDAD in adults and children receiving antibiotics.  | | Probiotics reduced the incidence of Clostridium difficile–associated diarrhea by 66% | | Annals of Internal Medicine |
The team searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, Allied and Complementary Medicine Database, Web of Science, and 12 gray-literature sources. The researchers selected randomized, controlled trials including adult or pediatric patients receiving antibiotics that compared any strain or dose of a specified probiotic with placebo or with no treatment control and reported the incidence of CDAD. There were 2 reviewers that independently screened potentially eligible articles, extracted data on populations, interventions, outcomes, and assessed risk of bias. The GRADE guidelines were used to independently rate overall confidence in effect estimates for each outcome. The team identified 20 trials including 3818 participants that met the eligibility criteria. Probiotics reduced the incidence of CDAD by 66%. The researchers found that in a population with a 5% incidence of antibiotic-associated CDAD, probiotic prophylaxis would prevent 33 episodes per 1000 persons. Of probiotic-treated patients, the team observed that 9% experienced adverse events, compared with 13% of control patients. Dr Johnston's team concludes, "Moderate-quality evidence suggests that probiotic prophylaxis results in a large reduction in CDAD without an increase in clinically important adverse events."
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