Probiotics for diarrhea in adults
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Probiotics for Diarrhea in Adults: A Comprehensive Review
Introduction to Probiotics and Diarrhea
Probiotics, which are live microorganisms that confer health benefits to the host when administered in adequate amounts, have been extensively studied for their potential to prevent and treat various forms of diarrhea in adults. This article synthesizes findings from multiple research studies to provide a clear understanding of the efficacy of probiotics in managing diarrhea, particularly antibiotic-associated diarrhea (AAD) and Clostridium difficile-associated diarrhea (CDAD).
Probiotics for Antibiotic-Associated Diarrhea (AAD)
Efficacy in Preventing AAD
Several studies have demonstrated that probiotics can significantly reduce the incidence of AAD in adults. A meta-analysis of 42 studies involving 11,305 participants found that co-administration of probiotics with antibiotics reduced the risk of AAD by 37% 2. Another meta-analysis of 36 studies with 9,312 participants reported a 38% reduction in AAD incidence with probiotic use 3. These findings are consistent across different probiotic species and dosages, with higher doses showing increased effectiveness 23.
Specific Probiotic Strains
The effectiveness of probiotics in preventing AAD varies by strain. Lactobacillus and Bifidobacterium genera have been particularly effective 2. A study focusing on Lactobacillus probiotics found a significant reduction in AAD risk, although the evidence was less conclusive for elderly patients 7.
Probiotics for Clostridium difficile-Associated Diarrhea (CDAD)
Prevention of CDAD
Probiotics have also been shown to be effective in preventing CDAD, a severe form of diarrhea often associated with antibiotic use. A systematic review and meta-analysis of 31 randomized controlled trials involving 8,672 patients found that probiotics reduced the risk of CDAD by 60% 1. Another meta-analysis of 26 RCTs with 7,957 patients reported a similar 60.5% reduction in CDAD incidence 10. These studies highlight the potential of probiotics, particularly Lactobacillus and Saccharomyces strains, in reducing CDAD risk 110.
Safety and Adverse Events
The use of probiotics in preventing CDAD appears to be safe, with a lower incidence of adverse events compared to control groups. Common adverse events included abdominal cramping, nausea, and flatulence, but these were generally mild and less frequent in the probiotic groups 1.
Probiotics for Acute Infectious Diarrhea
Treatment Efficacy
Probiotics may also be beneficial in treating acute infectious diarrhea. A review of 82 studies involving 12,127 participants found that probiotics reduced the duration of diarrhea by an average of 30.48 hours 6. However, the evidence was less clear for the prevention of diarrhea lasting 48 hours or longer, with some studies showing no significant difference between probiotic and control groups 4.
Strain-Specific Effects
The effectiveness of probiotics in treating acute infectious diarrhea also varies by strain. Lactobacillus rhamnosus GG and Saccharomyces boulardii have shown promise in reducing the duration and severity of diarrhea 46.
Conclusion
Probiotics have demonstrated significant potential in preventing and treating various forms of diarrhea in adults, particularly antibiotic-associated and Clostridium difficile-associated diarrhea. The evidence supports the use of specific probiotic strains, such as Lactobacillus and Bifidobacterium, for these conditions. While probiotics are generally safe, further research is needed to determine the optimal strains and dosages for different types of diarrhea.
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Most relevant research papers on this topic
Probiotics 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-Analysis
Very Rigorous Journal
Highly CitedProbiotics for the prevention of antibiotic-associated diarrhoea: a systematic review and meta-analysis
Probiotics effectively reduce the risk of antibiotic-associated diarrhoea in adults by 37%, with higher dosages and certain species showing increased effectiveness.
Meta-Analysis
Rigorous JournalHighly CitedProbiotics for the Prevention of Antibiotic-associated Diarrhea in Adults
Probiotics can effectively prevent antibiotic-associated diarrhea in adults when used early during antibiotic therapy without increased adverse events.
Meta-AnalysisProbiotics 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 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 CitedProbiotics for treating infectious diarrhoea.
Probiotics may be a useful adjunct to rehydration therapy in treating acute, infectious diarrhoea in adults and children.
Meta-AnalysisHighly CitedProbiotics Reduce the Risk of Antibiotic-Associated Diarrhea in Adults (18-64 Years) but Not the Elderly (>65 Years): A Meta-Analysis.
Probiotics are associated with a reduced risk of antibiotic-associated diarrhea in adults aged 18-64, but not in elderly individuals.
Meta-AnalysisLactobacillus probiotics in the prevention of diarrhea associated with Clostridium difficile: a systematic review and Bayesian hierarchical meta-analysis.
Lactobacillus probiotics show inconclusive evidence for preventing Clostridium difficile-associated diarrhea, with most studies conducted in low-risk populations, making their routine use in this area insufficient.
Meta-AnalysisProbiotics in Gastroenterology: How Pro Is the Evidence in Adults?
Probiotics show moderate to good evidence for treating recurrent Clostridium difficile infection, preventing antibiotic-associated diarrhea, and treating Helicobacter pylori, but their routine use is currently not recommended due to methodologic limitations.
Systematic ReviewProbiotics are effective at preventing Clostridium difficile-associated diarrhea: a systematic review and meta-analysis
Probiotic supplementation significantly reduces the risk of developing Clostridium difficile-associated diarrhea in patients receiving antibiotics.
Meta-AnalysisHighly Cited