Effectiveness of probiotics in preventing antibiotic-associated diarrhea in children: a systematic review and meta-analysis

Abstract

Antibiotic-associated diarrhea (AAD) is a common side effect of antibiotic therapy in children and is mostly brought on by disruption of the gut microbiota. Probiotics have been recommended as a prophylactic intervention, although the safety and effectiveness of these treatments in young populations are still up for debate. This systematic review and meta-analysis was conducted in accordance with PRISMA standards and registered under PROSPERO (CRD420251207959), to evaluate the safety and effectiveness of probiotics in reducing antibiotic-related diarrhea in children. The electronic databases were searched. Probiotics and antibiotics were used in randomized controlled studies to prevent AAD in children aged 0 to 18. The meta-analysis produced pooled odds ratios (ORs) with 95% confidence intervals (CIs) under a random-effects model using Review Manager (RevMan) version 5.3. Ten randomized controlled studies were included in the study. Probiotic use showed a non-significant tendency toward reducing the incidence of antibiotic-associated diarrhea when compared to the control group (OR≤0.58, 95% CI: 0.33-1.02; p≤0.06). The significant heterogeneity (I2≤71%) decreased to 43% after one study was removed from the sensitivity analysis. The absence of a significant difference in adverse effects between the probiotic and control groups (OR≤0.91; 95% CI: 0.40-2.10; p≤0.83) suggested a satisfactory safety profile. Probiotics had a non-significant trend in reducing antibiotic-associated diarrhea in children and were found to be safe with no increase in side effects. The observed variation highlighted the need for more meticulously designed large-scale randomized trials using specific probiotic strains and defined definitions of AAD to more precisely evaluate their preventative effects.