Systematic reviews have provided evidence for the efficacy of probiotics in preventing Clostridium difficile infection (CDI), but guidelines do not recommend probiotic use for prevention of CDI.
Dr Nicole Shen and colleagues from New York, USA performed an updated systematic review to help guide clinical practice.
The team searched MEDLINE, EMBASE, International Journal of Probiotics and Prebiotics, and The Cochrane Library databases for randomized controlled trials evaluating use of probiotics and CDI in hospitalized adults taking antibiotics.
There were 2 reviewers that independently extracted data and assessed risk of bias and overall quality of the evidence.
The team's primary and secondary outcomes were incidence of CDI and adverse events, respectively.
|The pooled relative risk of CDI in probiotic users was 0.42 |
Secondary analyses examined the effects of probiotic species, dose, timing, formulation, duration, and study quality.
The team analyzed data from 19 published studies, comprizing 6261 subjects.
The researchers found that the incidence of CDI in the probiotic cohort was lower than of controls.
The team noted that the pooled relative risk of CDI in probiotic users was 0.42.
The research team demonstrated that probiotics were significantly more effective if given closer to the first antibiotic dose, with a decrement in efficacy for every day of delay in starting probiotics.
Probiotics given within 2 days of antibiotic initiation produced a greater reduction of risk for CDI than later administration.
The team found no increased risk for adverse events among patients given probiotics.
The overall quality of the evidence was high.
Dr Shen's team concludes, "In a systematic review with meta-regression analysis, we found evidence that administration of probiotics closer to the first dose of antibiotic reduces the risk of CDI by more than 50% in hospitalized adults."
"Future research should focus on optimal probiotic dose, species, and formulation."