薬物代謝と毒性学ジャーナル
オープンアクセス

概要

Systematic Review: Lactobacilli and/or bifidobacteria in Preventing Antibiotics Associated Diarrhoea and C. Difficile Infection in Adults

Rafal Al-Nasiri

Background: The rate of Antibiotic Associated Diarrhoea (AAD) and Clostridium difficile associated diarrhoea (CDAD) have increased among hospitalized patients who are on long term of antibiotics therapy. Probiotics when combined with the usual treatment found to decrease the incidence rate of these cases. This systematic review evaluates the effectiveness of lactobacilli-based probiotics alone and multistrains of lactobacilli and bifido bacteria in AAD and CDAD.

Methods: Three databases: Google Scholar; PubMed and Cochrane central library were covered for randomized controlled trials from period 2005 till 2017. Studies were examined and filtered according to title/abstract and full text. The quality of included studies was assessed using Jadad scale.

Results: Eight articles were reviewed. Four articles investigated the use of various strains of lactobacilli-based probiotics among adult hospitalized patients who had already started antibiotics therapy. These showed that lactobacilli-based probiotics alone are effective in reducing both AAD and CDAD. Two of the studies used similar strains and similar doses, both resulted in significant reduction in diarrhoeal cases (OR 0.34; P=0.05) and (OR 0.667; P=0.067), respectively. While the other two studies showed less significance among hospitalized patients (OR 0.25 P=0.007, P< 0.001).

The other four articles investigated the use of lactobacilli probiotics in combination with bifodobacteria strains. Two studies were conducted on large number of patients using different doses of probiotics. Results showed these probiotics were not effective, AAD (P=0.71) and CDAD (P=0.35). One study showed the incidence of AAD was lower when higher dose of probiotics was used (P=0.08) while no difference in CDAD (P=0.02). The last study showed that patients who received Infloran(multistrainprobiotics) developed AAD and CDAD more than placebo group (P=0.246).

Conclusion: This review showed that lactobacilli-based probiotics alone are more effective in reducing AAD and CDAD than multistrain probiotics. More researches that involve large number of patients and use lactobacilli strains only are needed to imply its use in clinical settings.