Published online Dec 21, 2014. doi: 10.3748/wjg.v20.i47.17788
Revised: May 16, 2014
Accepted: July 24, 2014
Published online: December 21, 2014
Probiotics use has increased tremendously over the past ten years. This was coupled with a surge of data relating their importance in clinical practice. Antibiotic-associated diarrhea, whose frequency has risen recently, was one of the earliest targets with data published more than ten years ago. Unfortunately, available trials suffer from severe discrepancies associated with variability and heterogeneity of several factors. Most published randomized controlled trials and subsequent meta-analyses suggest benefit for probiotics in the prevention of antibiotic-associated diarrhea. The same seems to also apply when the data is examined for Clostridium difficile-associated colitis. However, the largest randomized double-blind placebo-controlled trial to date examining the use of a certain preparation of probiotics in antibiotic-associated diarrhea showed disappointing results, but it was flawed with several drawbacks. The commonest species of probiotics studied across most trials is Lactobacillus; however, other types have also shown similar benefit. Probiotics have enjoyed an impeccable safety reputation. Despite a few reports of severe infections sometimes leading to septicemia, most of the available trials confirm their harmless behavior and show similar adverse events compared to placebo. Since a consensus dictating its use is still lacking, it would be advisable at this point to suggest prophylactic use of probiotics to certain patients at risk for antibiotic-associated diarrhea or to those who suffered previous episodes.
Core tip: Probiotics use has been steadily increasing over the past ten years. One of the areas thoroughly examined includes prevention of antibiotic-associated diarrhea. Nonetheless, although trials are abundant, they are often confusing and conflicting. Adding insult to injury is the publication of the largest randomized controlled trial showing no benefit in prevention of antibiotic-associated diarrhea. We attempted to summarize, categorize and study the present literature detailing the important trials and their drawbacks in an attempt to come up with a reasonable consensus for their use.