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Early use of probiotics might prevent antibiotic-associated diarrhea in elderly (>65 years): a systematic review and meta-analysis
Systematic review of eight RCTs (4,691 older adults) found that probiotic initiation within two days of starting antibiotics was associated with lower antibiotic-associated diarrhea prevalence in meta-analytic subgroup analyses, whereas delayed initiation showed no clear effect.
Design
SR + MA; PubMed, EMBASE, Cochrane; PRISMA; RevMan 5.4.
Results (abstract narrative)
- Included trials: 8 RCTs; 4,691 participants (>65 y)
- Timing caveat: two large studies using probiotics >48 h after first antibiotic dose showed no effect and were excluded from the early-initiation framing.
- Subgroup: 6 RCTs with probiotics started within two days of antibiotics showed lower AAD prevalence in older adults (see forest plots for pooled risk metrics).
Evidence hygiene
Elderly inpatient antibiotic contexts dominate included trials—do not equate with community IBS strain-level networks on other rows.
Publication
Zhang L, et al. BMC Gastroenterol. 2022 Jul 2;22(1):286. PMID 35794520.
Outcomes
- Subgroup of six RCTs in adults >65 y: probiotics started within two days of antibiotic therapy associated with lower AAD prevalence versus delayed/no early-initiation strategies (see paper for pooled risk estimates).
- Two large RCTs initiating probiotics >48 h after first antibiotic dose showed no preventive effect—timing of initiation appears critical in this elderly pooled narrative.