A Cochrane review [Abstract] 1 included 4 studies with a total of 400 subjects. The studies examined the use of probiotics in conjunction with conventional antibiotics (vancomycin or metronidazole) for the treatment of recurrence or an initial episode of C. difficile colitis in adults. A statistically significant benefit for probiotics combined with antibiotics was found only in one study, where patients receiving S. boulardii were significantly less likely than patients receiving placebo to experience recurrence of C. difficile diarrhea (RR 0.59; 95% CI 0.35 to 0.98). No benefit of probiotics treatment was found in the other studies.
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies), by indirectness (differences in studied patients) and by imprecise results (few patients and wide confidence intervals).
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