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Systematic review with meta‐analysis: Saccharomyces boulardii in the prevention of antibiotic‐associated diarrhoea
Author(s) -
Szajewska H.,
Kołodziej M.
Publication year - 2015
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13344
Subject(s) - saccharomyces boulardii , medicine , relative risk , randomized controlled trial , number needed to treat , placebo , meta analysis , cochrane library , antibiotic associated diarrhea , antibiotics , medline , clostridium difficile , pediatrics , confidence interval , alternative medicine , probiotic , microbiology and biotechnology , genetics , pathology , bacteria , law , political science , biology
Summary Background Antibiotic‐associated diarrhoea is a common complication of antibiotic use, but it can be prevented with administration of probiotics. Aim To update our 2005 meta‐analysis on the effectiveness of Saccharomyces boulardii in preventing antibiotic‐associated diarrhoea in children and adults. Methods The Cochrane Library, MEDLINE , and EMBASE databases were searched up until May 2015, with no language restrictions, for randomised controlled trials; additional references were obtained from reviewed articles. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation ( GRADE ) guidelines. Results Twenty‐one randomised controlled trials (4780 participants), among which 16 were new trials, met the inclusion criteria for this updated systematic review. Administration of S. boulardii compared with placebo or no treatment reduced the risk of antibiotic‐associated diarrhoea (as defined by the study investigators) in patients treated with antibiotics from 18.7% to 8.5% (risk ratio, RR : 0.47; 95% CI : 0.38–0.57, number needed to treat, NNT : 10; 95% CI : 9–13). In children, S. boulardii reduced the risk from 20.9% to 8.8% (6 randomised controlled trials, n=1653, RR: 0.43, 95% CI: 0.3–0.6); in adults, from 17.4% to 8.2% (15 randomised controlled trials, n=3114, RR: 0.49, 95% CI: 0.38–0.63). Moreover, S. boulardii reduced the risk of Clostridium difficile‐ associated diarrhoea; however, this reduction was significant only in children (2 randomised controlled trials, n = 579, RR : 0.25; 95% CI : 0.08–0.73) and not in adults (9 randomised controlled trials, n = 1441, RR : 0.8, 95% CI : 0.47–1.34). Conclusions This meta‐analysis confirms that S. boulardii is effective in reducing the risk of antibiotic‐associated diarrhoea in children and adults.