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Comparative efficacy and tolerability of probiotics for antibiotic-associated diarrhea: Systematic review with network meta-analysis.
Network meta-analysis of 51 articles (9,569 participants) ranked Lactobacillus rhamnosus GG highest for preventing antibiotic-associated diarrhea (odds ratio 0.28 vs alternatives) with favorable tolerability; L. casei ranked best for C. difficile infection reduction in the network model.
Design
- Systematic review + network meta-analysis; 51 articles, 60 comparisons, n = 9,569; PROSPERO CRD 42016050776
- Interventions: 10 probiotic taxa/strategies vs various comparators for antibiotic-associated diarrhea (AAD)
Ranked efficacy / tolerability (abstract)
- LGG (Lactobacillus rhamnosus GG): highest probability of ranking best for effectiveness and tolerability — OR 0.28 (95% CI 0.17–0.47) vs other active agents for AAD prevention (network effect measure as reported)
- L. casei: best-ranked efficacy signal for reducing C. difficile infection in network (OR 0.04, 95% CI 0.00–0.77 — extremely wide)
- Strain combinations: no superiority vs single strains for efficacy or tolerability in abstract summary
Evidence hygiene
Network ORs are relative ranking tools—clinical choice still depends on antibiotic class, host factors, and trial transitivity.
Publication
Cai J, Zhao C, Du Y, et al. United European Gastroenterol J. 2018 Mar;6(2):169-180. PMID 29511547; PMC5833232.
Outcomes
- Network meta-analysis ranked Lactobacillus rhamnosus GG best for antibiotic-associated diarrhea prevention with OR 0.28 (95% CI 0.17–0.47) vs other probiotic agents in the comparative network (abstract).
- For Clostridioides difficile infection rate, Lactobacillus casei carried the best-ranked efficacy OR 0.04 (95% CI 0.00–0.77) with very wide uncertainty (abstract).