Systematic review with meta-analysis: Lactobacillus rhamnosus GG in the prevention of antibiotic-associated diarrhoea in children and adults
- 31 October 2015
- journal article
- review article
- Published by Wiley in Alimentary Pharmacology & Therapeutics
- Vol. 42 (10), 1149-1157
- https://doi.org/10.1111/apt.13404
Abstract
BackgroundThe effects of probiotics are strain specific. The clinical effects of each strain need to be evaluated separately. AimTo evaluate the efficacy of Lactobacillus rhamnosus GG (LGG) in the prevention of antibiotic-associated diarrhoea (AAD) in children and adults. MethodsThe Cochrane Library, MEDLINE, and EMBASE databases were searched up to July 2015, with no language restrictions, for randomised controlled trials (RCTs). Reference lists of reviews and included studies were examined. The quality of evidence (QoE) was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. ResultsTwelve RCTs (1499 participants) were included. Treatment with LGG compared with placebo or no additional treatment reduced the risk of AAD in patients treated with antibiotics from 22.4% to 12.3% (11 RCTs, n=1308, relative risk, RR: 0.49, 95% confidence interval, CI: 0.29-0.83, low QoE). However, when children and adults were evaluated separately, the difference was significant in children only (five RCTs, n=445, RR 0.48, 95% CI 0.26-0.89; moderate QoE). In adults, the difference was not significant (six RCTs, n=863, RR 0.48, 95% CI 0.20-1.15; low QoE), except for in a subset of patients receiving antibiotics as part of Helicobacter pylori eradication therapy (four RCTs, n=280, RR 0.26, 95% CI 0.11-0.59; low QoE). ConclusionsThis meta-analysis shows that Lactobacillus rhamnosus GG is effective in preventing antibiotic-associated diarrhoea in children and adults treated with antibiotics for any reason. However, the quality of evidence is moderate to low.Funding Information
- Warszawski Uniwersytet Medyczny
This publication has 28 references indexed in Scilit:
- Deciphering meta-analytic results: a mini-review of probiotics for the prevention of paediatric antibiotic-associated diarrhoea and Clostridium difficile infectionsBeneficial Microbes, 2015
- Probiotics for the Prevention and Treatment of Antibiotic-Associated DiarrheaJAMA, 2012
- GRADE guidelines: 2. Framing the question and deciding on important outcomesJournal of Clinical Epidemiology, 2011
- Isolation, Identification, and Characterization of Small Bioactive Peptides From Lactobacillus GG Conditional Media That Exert Both Anti‐Gram‐negative and Gram‐positive Bactericidal ActivityJournal of Pediatric Gastroenterology and Nutrition, 2009
- Antibiotic-associated diarrhoeaExpert Opinion on Drug Safety, 2006
- Is Lactobacillus rhamnosus GG Effective in Preventing the Onset of Antibiotic-Associated Diarrhoea: A Systematic ReviewDigestion, 2005
- Antibiotic-Associated DiarrheaNew England Journal of Medicine, 2002
- Lack of Effect of Lactobacillus GG on Antibiotic-Associated Diarrhea: A Randomized, Placebo-Controlled TrialMayo Clinic Proceedings, 2001
- Prophylactic Lactobacillus GGReduces Antibiotic-Associated Diarrhea in Children With Respiratory Infections: A Randomized StudyPublished by American Academy of Pediatrics (AAP) ,1999