Which probiotic has the best effect on preventing Clostridium difficile-associated diarrhea? A systematic review and network meta-analysis

source extracted confidence: high 2026-04-09
#adult #aged #anti-bacterial-agents #child #clostridioides-difficile

Which probiotic has the best effect on preventing Clostridium difficile-associated diarrhea? A systematic review and network meta-analysis

Ma et al., 2020 | J Dig Dis | Systematic Review

Citation

Ma Yan, Yang Jing Yu, ... Wang Chen. Which probiotic has the best effect on preventing Clostridium difficile-associated diarrhea? A systematic review and network meta-analysis. J Dig Dis. 2020-Feb;21(2):69-80. doi:10.1111/1751-2980.12839

Abstract

OBJECTIVE: Clostridium difficile-associated diarrhea (CDAD) accounts for up to 25% of patients with antibiotic-associated diarrhea (AAD). We aimed to determine which probiotic is most effective in preventing CDAD using a network meta-analysis. METHODS: Studies were identified by searching PubMed, EMBASE and the Cochrane Library databases for randomized controlled trials (RCTs) that evaluated the efficacy of probiotic interventions for CDAD. Primary outcomes were the incidence rates of AAD and CDAD, and secondary outcomes were the duration of diarrhea and the time until onset of diarrhea. The PROSPERO registered number of this study is CRD42018106115. RESULTS: Ten RCTs including 11 analyses and including 4 692 patients were identified. Compared with the control group, probiotic intervention reduced the incidence rates of CDAD (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.17-0.61) and AAD (OR 0.39, 95% CI 0.23-0.66). Similar results were observed regarding the duration of diarrhea and the time until onset of diarrhea. Meta-regression analysis showed a correlation between the type of probiotic used and the incidence of CDAD and AAD. All nine kinds of probiotic interventions were statistically more effective than the placebo, with Lactobacillus casei ranking as the best intervention (OR 0.19, 95% credible interval [CrI] 0.06-0.63) for decreasing the incidence rate of CDAD. L. casei also ranked the highest in reducing the incidence rate of AAD (OR 0.32, 95% CrI 0.14-0.74). CONCLUSION: Lactobacilli strains, especially L. casei, have a good effect on the prevention of CDAD and AAD.

Key Findings

Ten RCTs including 11 analyses and including 4 692 patients were identified. Compared with the control group, probiotic intervention reduced the incidence rates of CDAD (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.17-0.61) and AAD (OR 0.39, 95% CI 0.23-0.66). Similar results were observed regarding the duration of diarrhea and the time until onset of diarrhea. Meta-regression analysis showed a correlation between the type of probiotic used and the incidence of CDAD and AAD. All nine kin

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population antibiotic
Sample Size 692
Age Range See abstract
Condition See abstract

MeSH Terms

  • Adult
  • Aged
  • Anti-Bacterial Agents
  • Child
  • Clostridioides difficile
  • Clostridium Infections
  • Diarrhea
  • Enterocolitis, Pseudomembranous
  • Female
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Probiotics
  • Randomized Controlled Trials as Topic
  • Treatment Outcome

Evidence Classification

  • Level: Systematic Review
  • Publication Types: Journal Article, Systematic Review, Network Meta-Analysis
  • Vertical: probiotics

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09