The quality of evidence is downgraded by imprecise results (few events and the total sample size was less than calculated optimal information size).
A Cochrane review [Abstract] 1 included 31 studies with a total of 4492 subjects. Participants included adult and paediatric patients (0 to 18 years) receiving antibiotic therapy for any reason. A complete case analysis of those trials investigating CDAD (23 trials, 4213 participants) suggests that probiotics significantly reduce this risk by 64%. The incidence of CDAD was 2.0% in the probiotic group compared to 5.5% in the placebo or no treatment control group (RR 0.36; 95% CI 0.26 to 0.51). The incidence of C. difficile infection was 12.6% in the probiotics group compared to 12.7% in the placebo or no treatment control group (RR 0.89; 95% CI 0.64 to 1.24). Probiotics reduced the risk of adverse events by 20% (RR 0.80; 95% CI 0.68 to 0.95; 26 studies, 3964 participants). In both treatment and control groups the most common adverse events included abdominal cramping, nausea, fever, soft stools, flatulence, and taste disturbance. For a summary of results see Table 1.
| Outcome | Relative risk | Number of participants (studies) | Assumed risk (control) | Corresponding risk (probiotics) |
|---|---|---|---|---|
| Clostridium difficile associated diarrhea | RR 0.36 (0.26 to 0.51) | 4213 (23 studies) | 55 per 1000 | 20 per 1000 |
| Adverse events | RR 0.80 (0.68 to 0.95) | 3964 (26 studies) | 187 per 1000 | 150 per 1000 |
| Clostridium difficile infection | RR 0.89 (0.64 to 1.24) | 961 (13 studies) | 127 per 1000 | 113 per 1000 |
| Length of hospital stay | 422 (3 studies) | 10.3 days | 0.32 lower | |
| Antibiotic associated diarrhea | RR 0.60 (0.49 to 0.72) | 4097 (25 studies) | 209 per 1000 | 209 per 1000 |
Date of latest search: 2013-02-21
Primary/Secondary Keywords