Can probiotics make diarrhea worse
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Can Probiotics Make Diarrhea Worse?
Introduction to Probiotics and Diarrhea
Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. They are often used to manage various gastrointestinal issues, including diarrhea. However, there is ongoing debate about whether probiotics can sometimes exacerbate diarrhea instead of alleviating it.
Probiotics and Antibiotic-Associated Diarrhea (AAD)
Efficacy in Preventing AAD
Several studies have shown that probiotics can be effective in preventing antibiotic-associated diarrhea (AAD) in children and adults. A meta-analysis of 33 studies involving 6352 participants found that probiotics significantly reduced the incidence of AAD, with a relative risk reduction of 55%3. Another systematic review confirmed that probiotics, particularly high-dose formulations, are effective in reducing the incidence of AAD9.
Safety Concerns
Despite their benefits, there are safety concerns associated with probiotic use. Some studies have highlighted the risk of severe infections and antibiotic-resistant gene exchange, particularly in immunocompromised individuals1. However, most studies report that adverse events related to probiotics are rare and generally mild, such as rash, nausea, and bloating3 9.
Probiotics and Acute Infectious Diarrhea
Reduction in Duration and Severity
Probiotics have been shown to reduce the duration and severity of acute infectious diarrhea. A comprehensive review of 63 studies involving 8014 participants found that probiotics significantly reduced the mean duration of diarrhea by approximately 24 hours2. Another study involving 12,127 participants also found that probiotics reduced the duration of hospitalization for diarrhea, although the effect size varied7.
Limitations in Severe Cases
However, the benefits of probiotics may be limited in cases of severe dehydrating diarrhea. A study focusing on children with moderate to severe dehydration found no significant reduction in diarrhea duration or stool output with probiotic treatment6. This suggests that probiotics may be less effective in severe cases where rapid resolution of symptoms is critical.
Probiotics and Clostridium difficile-Associated Diarrhea (CDAD)
Preventive Effects
Probiotics have also been studied for their role in preventing Clostridium difficile-associated diarrhea (CDAD). A meta-analysis of 39 studies involving 9955 participants found that probiotics reduced the risk of CDAD by 60%4. This indicates a strong preventive effect, particularly in high-risk populations.
Safety in High-Risk Groups
While probiotics appear to be safe for most patients, including those at high risk for CDAD, there are concerns about their use in severely debilitated or immunocompromised individuals. Observational studies have reported serious adverse events in these populations, although such events were not observed in the included trials4.
Conclusion
Overall, probiotics are generally safe and effective in reducing the incidence and duration of various types of diarrhea, including AAD and acute infectious diarrhea. However, their benefits may be limited in severe cases, and there are safety concerns for immunocompromised individuals. More research is needed to fully understand the optimal use of probiotics in different patient populations and to address the potential risks associated with their use.
Sources and full results
Most relevant research papers on this topic
Probiotics and antibiotic-associated diarrhea in children: A review and new evidence on Lactobacillus rhamnosus GG during and after antibiotic treatment.
Probiotics, specifically Lactobacillus Rhamnosus GG and Saccharomyces boulardii, show potential in preventing and treating antibiotic-associated diarrhea in children, but safety concerns remain.
Systematic Review
Rigorous Journal
Highly CitedProbiotics for treating acute infectious diarrhoea
Probiotics, when used alongside rehydration therapy, appear to be safe and have clear beneficial effects in shortening the duration and reducing stool frequency in acute infectious diarrhoea.
Meta-Analysis
Very Rigorous JournalHighly CitedProbiotics for the prevention of pediatric antibiotic-associated diarrhea.
Probiotics effectively reduce the incidence of antibiotic-associated diarrhea in children compared to placebo or no treatment control.
Meta-AnalysisVery Rigorous JournalProbiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children.
Probiotics show potential in preventing Clostridium difficile-associated diarrhea in adults and children, but more research is needed to confirm their effectiveness and safety.
Meta-AnalysisVery Rigorous JournalHighly CitedProbiotic Lactobacillus casei: Effective for Managing Childhood Diarrhea by Altering Gut Microbiota and Attenuating Fecal Inflammatory Markers
Probiotic Lactobacillus casei may help reduce clinical severity and intestinal inflammation in children with acute diarrhea by altering gut microbiota and reducing fecal inflammatory markers.
RCTVery Rigorous JournalHighly CitedLimitations of Probiotic Therapy in Acute, Severe Dehydrating Diarrhea
Probiotics show limited benefits in treating short-duration diarrheal illnesses like viral enteritis, with their benefits likely being limited to prophylactic usage in high-risk populations.
RCTHighly CitedProbiotics for treating acute infectious diarrhoea
Probiotics show no significant difference in reducing the duration of acute infectious diarrhoea compared to placebo or no probiotic in a low-risk, very low-certainty study.
Meta-AnalysisVery Rigorous JournalHighly CitedMultispecies Probiotic for the Prevention of Antibiotic-Associated Diarrhea in Children: A Randomized Clinical Trial.
A multispecies probiotic reduced the overall risk of diarrhea in children during and for 7 days after antibiotic treatment, but did not significantly reduce antibiotic-associated diarrhea risk.
RCT
Large Human TrialVery Rigorous JournalProbiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatients—A Systematic Review and Meta-Analysis
Probiotics may help prevent antibiotic-associated diarrhea in outpatients and appear to be safe.
Meta-AnalysisHighly CitedEfficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebo-controlled trials.
Probiotics significantly reduce antibiotic-associated diarrhoea, travelers' diarrhoea, and acute diarrhoea of diverse causes, with varying effects depending on age and strain used.
Meta-AnalysisHighly Cited