Materiały źródłowe

• #1 Probiotics for Preventing Antibiotic-Associated Diarrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1200/od1.html

  Antibiotic-associated diarrhea was prevented in 1 out of 20 patients taking probiotics. […] There was a 5.1% reduction in antibiotic-associated diarrhea. […] AAD can occur in up to 35% of patients who receive antibiotics and is associated with higher health care costs and increased morbidity and mortality. […] Probiotics reduced the risk of AAD overall (13.7% vs. 18.8%; absolute risk difference = 5.1%; number needed to treat = 20; risk ratio [RR] = 0.63; 95% CI, 0.54 to 0.73; moderate-quality evidence). […] Probiotic use in patients at moderate (11% to 30%) and high (31% or greater) baseline risk of AAD demonstrated a significant overall reduction (RR = 0.61; 95% CI, 0.48 to 0.78, and RR = 0.55; 95% CI, 0.46 to 0.66, respectively). […] Despite significant limitations due to heterogeneity, this meta-analysis found that probiotics reduced the incidence of AAD with no observed serious adverse effects.

• #1 Prophylaxis and treatment of antibiotic-associated diarrhea: is there evidence for using probiotics?

  https://pulmonarychronicles.com/index.php/pulmonarychronicles/article/download/211/496

  Probiotics are defined as live microorganisms which when administered in adequate amounts confer a health benefit on the host. Synbiotics are preparations combining probiotic organisms and prebiotics (nondigestable food ingredients that can benefit the host by selectively stimulating bacteria in the colon). […] Probiotics are used to maintain or restore gut metabolism and microflora during and after antibiotic treatment. […] For individuals over the age of 65, limited evidence suggests that Bacillus licheniformis is the only strain that provides prophylaxis against AAD. […] The evaluation of therapeutic and prophylactic treatment options for AAD becomes important. […] Due to the patients age over 65, the most efficacious probiotic for prophylactic use prior to the onset of AAD would have been Bacillus licheniformis. […] Any probiotic strain as an adjunct therapy would also be beneficial in this patient, as studies have reported no significant difference among the different types of probiotics used.

• #1 Probiotics for the prevention of antibiotic-associated diarrhoea: a systematic review and meta-analysis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/34385227/

  Objective: To evaluate existing evidence for the use of probiotics in preventing antibiotic-associated diarrhoea (AAD) in adults. […] Results: Forty-two studies (11,305 participants) were included in this review. The pooled analysis suggests that co-administration of probiotics with antibiotics reduces the risk of AAD in adults by 37% (risk ratio (RR)=0.63 (95% CI 0.54 to 0.73), p0.00001). […] Conclusions: Probiotics are effective for preventing AAD. Secondary analyses of higher dosages and certain species have shown increased effectiveness. Our results may not be applicable in clinical scenarios of lower baseline AAD risk.

• #1 Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatients—A Systematic Review and Meta-Analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5745464/

  A common adverse effect of antibiotic use is diarrhea. Probiotics are living microorganisms, which, upon oral ingestion, may prevent antibiotic-associated diarrhea (AAD) by the normalization of an unbalanced gastrointestinal flora. […] The results suggest that probiotic use may be beneficial in the prevention of AAD among outpatients. Furthermore, the use of probiotics appears safe. […] The incidence of AAD in the probiotic group was 8.0%, compared to 17.7% in the control group. The overall pooled results showed that the use of probiotics produced a statistically significant reduction in the incidence of AAD: RR 0.49; 95% CI 0.36 to 0.66. […] The use of probiotics for the prevention of antibiotic-associated diarrhea reduces the risk of AAD by 51% (RR 0.49; 95% CI 0.36 to 0.67) with a moderate quality of evidence according to GRADE. This result was confirmed in analyses of specific strains, namely Lactobacillus rhamnosus GG and Saccharomyces boulardii. Furthermore, we found preliminary evidence to suggest a dose-response relationship.

• #1 Probiotics use for antibiotic-associated diarrhea: a pragmatic participatory evaluation in nursing homes | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-020-01297-w

  Antibiotic-associated diarrhea (AAD) occurs in 225% of nursing home residents, which may lead to dehydration, malnutrition, severe complications and hospitalizations. Research shows that probiotics can be effective and safe in reducing AAD. […] The number of episodes with AAD when using probiotics was significantly lower than when no probiotics was used (20% vs 36%; p=0,022, Chi-square). […] Successful implementation of probiotics demonstrated the prevention of AAD in nursing home residents. […] Overall, it appears that probiotic use may be beneficial in the prevention of AAD in all age groups, although not all types of probiotics seem to be equally effective in preventing AAD in older populations. […] The present PPE showed that this multispecies probiotics significantly reduced AAD in nursing home residents. […] In conclusion, successful implementation of probiotics demonstrated a reduction in the occurrence of AAD in nursing home residents.

• #1

  https://www.racgp.org.au/clinical-resources/clinical-guidelines/handi/handi-interventions/nutrition/probiotics-for-the-prevention-of-antibiotic

  Probiotics for the prevention of antibiotic-associated diarrhoea in adults and children. […] There is some evidence that the benefits of probiotics are strain-specific. Lactobacillus rhamnosus GG and Saccharomyces boulardii appear to be the most efficacious choice for preventing antibiotic-associated diarrhoea, while Lactobacillus casei may be the best for specifically preventing severe C. difficile-related diarrhoea. […] To reduce risk of antibiotic-associated diarrhoea in those at higher risk. […] Longer duration of antibiotic use (3 days) is more likely to cause antibiotic-associated diarrhoea. […] Children aged 2 years and people who are frail or with co-morbid conditions may have a higher risk of antibiotic-associated diarrhoea than the general population. […] However, given its efficacy in prevention, the use of probiotics in AAD would be reasonable.

• #1 Antibiotic-Associated Diarrhea – Canadian Digestive Health Foundation

  https://cdhf.ca/en/antibiotic-associated-diarrhea/

  Preventing AAD: Wash your hands regularly with soap and warm water for at least 20 seconds. And periodically clean high-use surface areas, such as the kitchen and bathroom. […] Use antibiotics wisely, as prescribed. Never use antibiotics prescribed for someone else and never use left over antibiotics from a previous illness. […] Another option is probiotics such as Florastor which add “helpful” or “good” micro-organisms (yeast) to the digestive system (Cannon, 2019; Barbut & Meynard, 2002). […] Many studies have demonstrated that probiotics may help prevent or reduce the risk of antibiotic-associated diarrhea (Barbut & Meynard, 2002). […] It has been proven that Florastor probiotics reduces the incidence of antibiotic-associated diarrhea by up to 80% in children and up to 84% in adults (Kotowska et. Al, 2005). […] In summary, yes there is evidence which suggests that S. boulardii can help restore the balance of gut microorganisms. But before starting probiotics, consult with your health care professional.

• #1 Preventing pediatric antibiotic-associated diarrhea and Clostridium difficile infections with probiotics: A meta-analysis

  https://www.wjgnet.com/2308-3840/full/v1/i3/102.htm

  In conclusion, our meta-analyses found probiotics are beneficial and safe in the prevention of pediatric AAD and pediatric CDI and, while only two strains had sufficient evidence to conclude they are efficacious for the prevention of AAD (S. boulardii lyo and L. rhamnosus GG), other probiotic strains are promising.

• #1 Probiotics to Prevent Antibiotic-Associated Diarrhea in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0301/od2.html

  1 in 6 did not develop antibiotic-associated diarrhea when receiving high-dose probiotics (especially those containing Saccharomyces boulardii and Lactobacillus rhamnosus) […] Studies have demonstrated that probiotics are safe and effective when used in conjunction with antibiotics for preventing antibiotic-associated diarrhea in otherwise healthy children. […] Analyses indicated that probiotics coadministered with antibiotics moderately reduced the incidence of antibiotic-associated diarrhea in this patient population compared with active alternative prophylaxis, placebo, and no treatment. […] High-dose probiotics (5 billion colony-forming units [CFUs] or more per day) were found to be superior in reducing the incidence of antibiotic-associated diarrhea compared with low-dose probiotics (less than 5 billion CFUs per day). […] The number needed to treat (NNT) with probiotics to prevent one case of antibiotic-associated diarrhea was 9, and the NNT improved to 6 when using high-dose probiotics (95% CI, 5 to 9).

• #1 Probiotics for the prevention of antibiotic-associated diarrhoea: a systematic review and meta-analysis | BMJ Open

  https://bmjopen.bmj.com/content/11/8/e043054

  Probiotics for the prevention of antibiotic-associated diarrhoea: a systematic review and meta-analysis […] The pooled analysis suggests that co-administration of probiotics with antibiotics reduces the risk of AAD in adults by 37% (risk ratio (RR)=0.63 (95% CI 0.54 to 0.73), p0.00001). […] Probiotics are effective for preventing AAD. […] Secondary analyses of higher dosages and certain species have shown increased effectiveness. […] The principal finding of this review is that probiotics significantly reduce the risk of AAD in adults, with an NNT of 20 patients. […] Our results show evidence of a placebo effect, with a reduction in risk of AAD of 31% when probiotics were compared with placebo, but 65% when probiotics were compared with no treatment. […] In studies that compared dosage of the same probiotic, higher doses were found to be significantly more effective, suggesting a recommended dose of greater than 10 billion cfu per day. […] This review has demonstrated overall effectiveness of probiotics for the prevention of AAD, including a doseresponse and some species-specific effectiveness of probiotics.

• #1 Probiotics as a possible treatment antibiotic-associated diarrhea in the ICU | Rho Chi Post

  https://rhochistj.org/RhoChiPost/probiotics-as-a-possible-treatment-antibiotic-associated-diarrhea-in-the-icu/

  Antibiotic-associated diarrhea (AAD) can occur due to antibiotics changing the elements of the gut and thereby, increasing an organisms inhabitance. Diarrhea is common in as many as 40% of critically ill patients. An even greater problem is Clostridium difficile (antibiotics-associated) becoming a leading cause of mortality in hospital-related infections. Probiotics help prevent C. difficile infection in small scale studies; however, the results are still unclear in large-scale studies. […] Studies have shown that probiotics are safe to use in AAD patients. Probiotic use in AAD patients has increased with access to over-the-counter products. After reviewing 16 studies and 3400 patients, a Cochrane Review determined Lactobacillus rhamnosus GG and S. boulardii to be effective probiotics in preventing ADD. In a single-center, randomized, double-blind, placebo-controlled dose-ranging study by Gao et al, hospitalized adult-patients were treated with a probiotic containing 50 billion colony-forming units of Lactobacillus. Patients that received two capsules daily had a lower incidence of AAD (15.5%) than patients who received only one capsule (28.8%) or placebo (44.1%).

• #1

  https://journals.lww.com/jcge/fulltext/2021/07000/probiotics_for_the_prevention_of.4.aspx

  This meta-analysis aims to combine the latest research evidence to assess the effect of probiotics on preventing antibiotic-associated diarrhea (AAD) in adults. […] Probiotics reduced the incidence of AAD by 38% (pooled relative risk, 0.62; 95% confidence interval, 0.51-0.74). […] This updated meta-analysis suggested that using probiotics as early as possible during antibiotic therapy has a positive and safe effect on preventing AAD in adults. […] Our study suggests that using probiotics within 2 days during antibiotic treatment significantly reduces the incidence of AAD in adults and is safe. […] Our meta-analysis suggested that during antibiotic treatment, taking probiotics as early as possible has a positive and safe effect on preventing antibiotic-related diarrhea in adults.

• #1 The Effectiveness of Synbiotics in Preventing Antibiotic-Associated Diarrhea in Children: A Double-Blind Randomized Clinical Trial

  https://brieflands.com/articles/apid-89707

  The current study has shown that the use of synbiotics within 24 hours following the antibiotic therapy initiation caused a statistically fewer occurrence of AAD in the case group compared with the control group, and the logistic regression test shows that children who were not under synbiotic therapy were at 2.4 times higher risk of AAD in comparison to the case group. […] In summary, the findings of this study showed that early initiation of synbiotics and its long-term administration following antibiotic therapy cessation could considerably prevent antibiotic-associated diarrhea incidence. However, synbiotics use could not positively affect the duration, stool consistency, and frequency of defecation a day in AAD-affected patients.

• #1

  https://www.racgp.org.au/clinical-resources/clinical-guidelines/handi/handi-interventions/nutrition/probiotics-for-the-prevention-of-antibiotic

  Probiotics have been shown to reduce antibiotic-associated diarrhoea in adults and children, in admitted and ambulatory patient settings, with different probiotic species, with lower or higher doses of probiotics and in studies at high or low risks of bias. […] Probiotic use is a low-risk, low-cost useful intervention for people at a higher risk of antibiotic-associated diarrhoea. […] Probiotics can be taken during and/or after antibiotic dosing. […] However, probiotic use for the minimum of the antibiotic treatment duration would be reasonable.

• #1 Probiotics for the Prevention of Pediatric Antibiotic-Associated Diarrhea

  https://www.drugtopics.com/view/probiotics-for-the-prevention-of-pediatric-antibiotic-associated-diarrhea

  Although evidence supporting a clinically meaningful interaction between probiotics and antibiotics is lacking, the use of antibiotics could theoretically eradicate the microorganisms contained in the probiotics. Therefore, it has been suggested to space the administration of probiotics from antibiotics by 2 hours. […] After applying search criteria, 7 relevant articles were identified, which are summarized below. […] The investigators concluded that using S boulardii was effective for the prevention of AAD in children. […] The investigators concluded that the specific probiotic-rich yogurt used in the trial was an effective intervention for reducing the incidence of antibiotic-associated gastrointestinal disturbance in children. […] The investigators concluded that there was no beneficial effect of Lactobacillus plantarum for the prevention of AAD in children.

• #1 Antibiotic-associated diarrhea – sboulardii – CNCM i-745

  https://www.saccharomycesboulardii.com/therapeutic-area/antibiotic-associated-diarrhea/

  The single-strain yeast probiotic Saccharomyces boulardii CNCM I-745 is proven to help reduce the occurrence of antibiotic-associated diarrhea.6 For example, it has been demonstrated that the occurrence of diarrhea is reduced by 53% in adults when Saccharomyces boulardii CNCM I-745 is taken at the same time as antibiotics.6 […] Unlike bacterial probiotics, S. boulardii CNCM I-745 is naturally resistant to antibiotics which means that it can be taken at the same time as antibiotics to act on the immediate effect of the antibiotics on the microbiota and reduce the risk of antibiotic-associated diarrhea.8

• #1 Early use of probiotics might prevent antibiotic-associated diarrhea in elderly (>65 years): a systematic review and meta-analysis | BMC Geriatrics | Full Text

  https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-03257-3

  Antibiotic-associated diarrhea (AAD) is diarrhea associated with consuming antibiotics that cannot be explained by other causes. AAD prolongs admission time and increases mortality and financial costs. Elderly individuals are more prone to receive antibiotic treatment and develop AAD. […] We recommend that elderly individuals could be routinely distributed probiotics to prevent AAD development when receiving antibiotic treatment. […] Probiotics consist of Streptococcus thermophilus, Enterococcus species, yeast species, and various Lactobacillus and bifidobacteria. Primary and secondary studies have shown that using probiotics during antibiotic administration can decrease the incidence of antibiotic-associated diarrhea. […] We explored the association between the time of using the first dose of probiotics and the incidence of AAD in elderly individuals, which is the innovation of a recent study. We conclude that probiotics reduce AAD incidence in the elderly, as first observed. […] In summary, we recommend that elderly individuals routinely distribute probiotics to prevent AAD development when receiving antibiotic treatment.

• #1 Antibiotic-associated diarrhea | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/antibiotic-associated-diarrhea

  Antibiotic-associated diarrhea can occur in anyone who takes an antibiotic. But you’re more likely to develop antibiotic-associated diarrhea if you: […] To help prevent antibiotic-associated diarrhea, try to: […] Take antibiotics only when necessary. Don’t use antibiotics unless your doctor feels they’re necessary. Antibiotics can treat bacterial infections, but they won’t help viral infections, such as colds and flu. […] Tell your doctor if you’ve had antibiotic-associated diarrhea or C. difficile before. Having antibiotic-associated diarrhea once or C. difficile in the past increases the chance that antibiotics will cause that same reaction again. Your doctor may be able to select a different antibiotic for you.

• #1 Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatients—A Systematic Review and Meta-Analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5745464/

  The use of probiotics appears safe. However, our study still suggests that caution be applied prior to widespread introduction of probiotic treatment for AAD as only 18% of the included studies had a low risk of bias, and these studies did not find a statistically significant reduction in the prevention of AAD.

• #1 Probiotics for the prevention of antibiotic-associated diarrhea in children | Cochrane

  https://www.cochrane.org/CD004827/IBD_probiotics-prevention-antibiotic-associated-diarrhea-children

  Evidence suggested that probiotics are effective for a moderate reduction in duration of diarrhea (almost one day). […] Among the various probiotics evaluated, Lactobacillus rhamnosus or Saccharomyces boulardii at 5 to 40 billion colony forming units/day appear most appropriate for preventing AAD in children receiving antibiotics. […] The overall evidence suggests a moderate protective effect of probiotics for preventing AAD (NNTB 9, 95% CI 7 to 13). […] Evidence also suggests that probiotics may moderately reduce the duration of diarrhea, a reduction by almost one day. […] Adverse event rates were low and no serious adverse events were attributable to probiotics. […] Common adverse events included rash, nausea, gas, flatulence, abdominal bloating, and constipation.

• #1 Probiotics for the Prevention of Pediatric Antibiotic-Associated Diarrhea

  https://www.drugtopics.com/view/probiotics-for-the-prevention-of-pediatric-antibiotic-associated-diarrhea

  Diarrhea is a common adverse effect of antibiotics, affecting 11% to 40% of children treated with broad-spectrum antibiotics. Antibiotic-associated diarrhea (AAD) may occur when antibiotics disrupt the normal balance of the gut flora, causing harmful bacteria to multiply and destroy the gut microflora. Probiotics restore the natural balance of gut flora through the introduction of nonpathogenic bacterial or yeast microbiota and have been used in clinical trials and in practice to manage AAD in children. […] Probiotics should be avoided in children who are immunocompromised or severely debilitated. Likewise, probiotics must be used with caution in specific populations such as premature infants, critically ill patients, and patients with a central venous catheter, cardiac valvular disease, and short-gut syndrome.

• #1 Antibiotics Diarrhea: Causes, Treatment, and Prevention

  https://www.healthline.com/health/antibiotics-diarrhea

  Only take antibiotics when needed. While antibiotics can treat bacterial infections, theyre not effective against viral infections like colds and flu. Overusing antibiotics can negatively impact your digestive health and cause other issues. […] Talk to your doctor. If youve had diarrhea when taking antibiotics before, let your doctor know. They may be able to prescribe an antibiotic that has a lower likelihood of causing this issue.

• #1 Antibiotics Diarrhea: Causes, Treatment, and Prevention

  https://www.healthline.com/health/antibiotics-diarrhea

  Antibiotic-associated diarrhea is fairly common. Its estimated that between 5 and 25 percent of adults may experience diarrhea while taking antibiotics. […] There are some steps that you can take to lower your risk of developing antibiotic-associated diarrhea. Some suggestions include: […] Try probiotics. Probiotics can help add good bacteria back into your digestive system. Some recent reviews of scientific literature have found that using probiotics while taking antibiotics can be effective for preventing diarrhea. […] Practice good hygiene. Washing your hands frequently, especially after using the bathroom, can help prevent the spread of C. diff bacteria. […] Follow medication instructions. Some antibiotics may say to take with food. Be sure to do this to help prevent digestive irritation.

• #1 Patient education: Antibiotic-associated diarrhea caused by Clostridioides difficile (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antibiotic-associated-diarrhea-caused-by-clostridioides-difficile-beyond-the-basics/print

  Alcohol-based hand rubs may be less effective against C. difficile; using soap and running water is recommended if there is an outbreak of C. difficile infection. […] Contact precautions—People who are hospitalized with C. difficile are placed on contact precautions, which mean that anyone who enters the patient’s room must wash their hands before entering and after leaving. The person must also wear a clean gown (over their clothes) and clean gloves. These measures can help to prevent the spread of infection to other people in the hospital.

• #1 Travelers’ Diarrhea | Yellow Book | CDC

  https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/travelers-diarrhea

  Vaccines are not available in the United States for pathogens that commonly cause TD. Traveler adherence to recommended approaches can, however, help reducealthough never fully eliminatethe risk for illness. These recommendations include making careful food and beverage choices, using agents other than antimicrobial medications for prophylaxis, and carefully washing hands with soap whenever available. […] The primary agent studied for prevention of TD, other than antibiotics, is bismuth subsalicylate (BSS). Studies from Mexico have shown that this agent reduces the incidence of TD by approximately 50%. […] Probiotics (e.g., Lactobacillus GG, Saccharomyces boulardii) have been studied in small numbers of people as TD prevention, but results are inconclusive, partly because standardized preparations of these bacteria are not reliably available.

• #1 Lactoferrin for the Prevention of Antibiotic- Associated Diarrhea in Adult | National Agricultural Library

  https://www.nal.usda.gov/research-tools/food-safety-research-projects/lactoferrin-prevention-antibiotic-associated-diarrhea

  Patients treated with antibiotics frequently develop diarrhea. […] Results from in vitro and preliminary in vivo studies lead us to hypothesize that oral administration of recombinant human lactoferrin as a medical food might be able to prevent and reduce antibiotic associated diarrhea in adults. […] We expect that the study will prove that recombinant human lactoferrin is able to reduce incidence of antibiotic associated diarrhea by 50% and if patients do get diarrhea, the diarrhea days will be shorten by half. […] Oral administration of recombinant human lactoferrin might be able to prevent antibiotic associated diarrhea in adults and the present proposal is to test this hypothesis.

• #1 The Effectiveness of Synbiotics in Preventing Antibiotic-Associated Diarrhea in Children: A Double-Blind Randomized Clinical Trial

  https://brieflands.com/articles/apid-89707

  Antibiotic-associated diarrhea (AAD) is of great concern in children due to the wide range of antibiotic administration among this population. […] In the current study, the effectiveness of synbiotics in preventing AAD was investigated. […] The incidence of AAD was significantly less in the case group compared with the control group (P = 0.016), while those with AAD did not show significant difference regarding the duration of diarrhea, stool consistency based on BSS, and the frequency of defecation a day (P = 0.51, 0.26, and 0.18, respectively). […] The findings of this study showed that early initiation of synbiotics and its long-term administration following antibiotic therapy cessation could considerably prevent AAD; however, in case of AAD occurrence synbiotic therapy cannot positively affect duration, stool consistency, and the frequency of defecation.

• #1 Travelers’ Diarrhea | Yellow Book | CDC

  https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/travelers-diarrhea

  Older controlled studies showed that use of antibiotics reduced diarrhea attack rates by 90%. For almost all travelers, though, the risks associated with the use of prophylactic antibiotics, including side effects, Clostridioides difficile infection, and increased risk of carriage of antimicrobial-resistant bacteria, do not outweigh the benefits. Prophylactic antibiotics might rarely be considered for short-term travelers who are high-risk hosts (e.g., immunocompromised people or people who have significant medical comorbidities). […] Prophylactic antibiotics are not recommended for most travelers. Prophylactic antibiotics afford no protection against nonbacterial pathogens and can remove normally protective microflora from the bowel, increasing the risk for acquisition of resistant bacterial pathogens.

• #1 Antibiotic-Associated Diarrhea – Canadian Digestive Health Foundation

  https://cdhf.ca/en/antibiotic-associated-diarrhea/

  Antibiotic-associated diarrhea (AAD) is a common complication of antibiotic treatment. It refers to the passage of loose, watery stool, at least three times per day, in individuals who are taking or recently took antibiotics (Kelly & Lamont, 2021; Gianelli 2017). […] Most cases of AAD are mild, requiring no further treatment. However, sometimes a more serious type of AAD can occur which is caused by the bug (bacterium) Clostridioides difficile, also known as C. diff for short (Barbut & Meynard, 2002). […] Here are some strategies to adopt if you have diarrhea: Hydration: Drink plenty of fluids containing adequate amounts of water, sugar and salts to stay hydrated. It is important to counteract the fluid and electrolyte lost though diarrhea. […] Contact your health care provider: If you have mild diarrhea, your symptoms will generally clear up once the antibiotic therapy is completed. However, in some cases your doctor may decide to stop the antibiotic until symptoms resolve.

• #1 Antibiotic-associated diarrhea | Content for the lay public | Microbiota institute

  https://www.biocodexmicrobiotainstitute.com/en/antibiotic-associated-diarrhea

  Antibiotics are a powerful tool in the fight against bacterial infections. While treatments sometimes appear to be without obvious short-term side effects, the gut microbiota imbalance they provoke can cause diarrhea in up to 35% of patients. This antibiotic-associated diarrhea (AAD) can at times cloak serious intestinal infections. […] AAD can affect up to 35% of patients and up to 80% of children receiving antibiotic treatment. […] The management of AAD depends on the symptoms and the pathogen (e.g. C. difficile). For mild to moderate diarrhea, treatment involves ending antibiotic use (or replacing the antibiotic with one less likely to cause diarrhea) to allow the microbiota to recover and the patient to rehydrate. […] Numerous studies have shown that probiotics may help reconstitute the gut microbiota, while some probiotics have proven effective in preventing and treating AAD. When taken during antibiotic treatment, other probiotics have been shown to reduce the risk of primary and secondary infection with C. difficile. […] Lastly, fecal microbiota transplantation (naturally transferring a healthy microbiota into a sick individual in order to restore his or her microbial ecosystem) is currently only used for the most serious infections, i.e. relapses of infections with C. difficile.

• #1 Antibiotic-Associated Diarrhea: Causes, Treatment, Prevention

  https://www.verywellhealth.com/antibiotics-and-diarrhea-1941560

  Antibiotic-associated diarrhea is more common when: […] To prevent dehydration, drink plenty of water (around eight to ten 8-ounce glasses per day) with an occasional sports drink to maintain electrolyte levels. […] In 2020, the American Gastroenterology Association released a statement suggesting some adults and children on antibiotic treatment may benefit from taking a probiotic as a measure to help prevent infection with C. difficile bacteria. […] In some cases, healthcare providers will recommend that probiotics be added to your diet while taking antibiotics.

• #1 Can Antibiotics Cause Diarrhea? Symptoms, Treatment, and Prevention Tips

  https://www.everydayhealth.com/digestive-health/can-antibiotics-cause-diarrhea/

  Research shows that probiotics help to prevent antibiotic-associated diarrhea in both children and adults. […] To replenish fluids, drink more clear liquids (water, broth) and drinks that contain electrolytes, such as a sports drink or oral rehydration solution. […] While there’s no specific diet for diarrhea, it’s best to eat foods that are gentle on your stomach, like bananas, rice, baked potato, toast, or crackers. Foods that contain probiotics, like Greek yogurt, can help to reset the correct balance of good-to-bad bacteria in your gut. […] To help prevent antibiotic-associated diarrhea, take antibiotics only when absolutely necessary to treat a bacterial infection, and eat foods rich in probiotics or take a supplement. […] Manage diarrhea by getting plenty of fluids and electrolytes, and eating a bland diet until this symptom resolves.

• #1 Antibiotic-associated diarrhea – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/antibiotic-associated-diarrhea/diagnosis-treatment/drc-20352237

  To cope with diarrhea: […] In some cases of mild antibiotic-associated diarrhea, your doctor may recommend anti-diarrheal medications, such as loperamide (Imodium A-D). […] People may turn to probiotics found in foods such as yogurt with the hope that they can rebalance the healthy bacteria in their digestive tract. But, there’s no consensus on whether or not over-the-counter probiotics can help lessen the symptoms of antibiotic-associated diarrhea. […] To cope with diarrhea until your appointment, you can: […] Drink more water and other liquids to replace fluids lost because of diarrhea […] Eat bland foods and avoid spicy or greasy foods that can aggravate diarrhea.

• #1 Antibiotic-Associated Diarrhea – Harvard Health

  https://www.health.harvard.edu/a_to_z/antibiotic-associated-diarrhea-a-to-z

  If you are caring for someone who has diarrhea, you may be able to avoid spreading potentially harmful bacteria by taking these steps: […] For cases of mild antibiotic-associated diarrhea, try the following suggestions: […] If you have more severe diarrhea due to a C. difficile infection, your doctor probably will stop your antibiotic treatment and prescribe an oral antimicrobial drug called vancomycin or fidaxomicin. […] Call your doctor promptly if you have been taking antibiotics and you develop any of the following symptoms: […] Overall, the prognosis is excellent. Almost all adults with mild antibiotic-associated diarrhea recover completely without complications.

• #1 Probiotics for the Prevention of Antibiotic-Associated Diarrhea

  https://www.mdpi.com/2227-9032/10/8/1450

  Probiotics are a vast market filled with various strains with unspecified benefits. […] Probiotics have become quite accessible to the public, as one can find a source in most supermarkets, pharmacies, and supplement stores. […] The Canadian Agency for Drugs and Technologies in Health (CADTH) carried out an evaluation of probiotics for AAD in the pediatric population. […] A strong recommendation was made for the use of L rhamnosus GG and S. boulardii for preventing AAD in children. […] The American Gastroenterological Association (AGA) suggested the use of certain organisms such as S. boulardii, or combinations of strains, for example, L. acidophilus CL1285 and L. casei, for adults and children who are being treated with antibiotics. […] The potential to alter these microbial ecosystems offers great hope for new preventative treatment options for antibiotic-associated diarrhea and other gastrointestinal disorders. […] Several studies show benefits of the use of probiotics for AAD, but still call for large placebo-controlled trials to determine species and dose effectiveness for prevention.

• #1 Probiotics for antibiotic-associated diarrhea: Do we have a verdict?

  https://www.wjgnet.com/1007-9327/full/v20/i47/17788.htm

  The literature suggests that CDAD can occur after just one dose of antibiotics and may appear up to several weeks after completion of antibiotic therapy. […] The 2010 Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for the treatment of CDI do not recommend the use of probiotics for the prevention of CDAD due to lack of evidence and risk of blood stream infection. […] Their analysis of different probiotic strains and types showed benefit across the board regardless of the genus or species. […] The appeal of using probiotics comes clearly from their ready availability, low cost and acceptable known safety profile. […] With the current data at hand, it is difficult to draw any solid conclusion about the prophylactic use of probiotics in AAD. It would be reasonable to advise their use in some specific populations such as patients with a history of AAD or risk factors for the development of CDAD.

• #2 Antibiotic-Associated Diarrhea Treatment | Gastro Health

  https://gastrohealth.com/news/patient-care/what-you-might-not-know-about-antibiotics

  Antibiotics are widely used in the prevention and treatment of infectious diseases. While antibiotics are safe for most people, it has been proven that a common side effect of the treatment is diarrhea. […] According to several studies, diarrhea occurs between 5% and 39% of patients receiving antibiotics, depending on the population and the type of antibiotic. […] The treatment of antibiotic-associated diarrhea consists of several steps: Stopping the antibiotic causing the problem is an important initial step. Administration of probiotics, which are live microorganisms (in most cases bacteria) that are similar to the beneficial microorganisms found in the human gastrointestinal tract. When administered in adequate amounts, they confer a health benefit on the host, in preventing and treating antibiotic-associated diarrhea.

• #2 Probiotics for the Prevention of Antibiotic-Associated Diarrhea in Outpatients—A Systematic Review and Meta-Analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5745464/

  A common adverse effect of antibiotic use is diarrhea. Probiotics are living microorganisms, which, upon oral ingestion, may prevent antibiotic-associated diarrhea (AAD) by the normalization of an unbalanced gastrointestinal flora. […] The results suggest that probiotic use may be beneficial in the prevention of AAD among outpatients. Furthermore, the use of probiotics appears safe. […] The incidence of AAD in the probiotic group was 8.0%, compared to 17.7% in the control group. The overall pooled results showed that the use of probiotics produced a statistically significant reduction in the incidence of AAD: RR 0.49; 95% CI 0.36 to 0.66. […] The use of probiotics for the prevention of antibiotic-associated diarrhea reduces the risk of AAD by 51% (RR 0.49; 95% CI 0.36 to 0.67) with a moderate quality of evidence according to GRADE. This result was confirmed in analyses of specific strains, namely Lactobacillus rhamnosus GG and Saccharomyces boulardii. Furthermore, we found preliminary evidence to suggest a dose-response relationship.

• #2 Probiotics for Preventing Antibiotic-Associated Diarrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1200/od1.html

  Antibiotic-associated diarrhea was prevented in 1 out of 20 patients taking probiotics. […] There was a 5.1% reduction in antibiotic-associated diarrhea. […] AAD can occur in up to 35% of patients who receive antibiotics and is associated with higher health care costs and increased morbidity and mortality. […] Probiotics reduced the risk of AAD overall (13.7% vs. 18.8%; absolute risk difference = 5.1%; number needed to treat = 20; risk ratio [RR] = 0.63; 95% CI, 0.54 to 0.73; moderate-quality evidence). […] Probiotic use in patients at moderate (11% to 30%) and high (31% or greater) baseline risk of AAD demonstrated a significant overall reduction (RR = 0.61; 95% CI, 0.48 to 0.78, and RR = 0.55; 95% CI, 0.46 to 0.66, respectively). […] Despite significant limitations due to heterogeneity, this meta-analysis found that probiotics reduced the incidence of AAD with no observed serious adverse effects.

• #2

  https://www.healio.com/news/gastroenterology/20150923/meta-analysis-supports-efficacy-of-probiotic-for-preventing-antibiotic-associated-diarrhea

  A recent systematic review and meta-analysis showed moderate-to-low quality evidence that the probiotic Lactobacillus rhamnosus GG effectively prevents antibiotic-associated diarrhea in both children and adults. […] The daily dose of LGG ranged from 4 x 108 to 12 x 1010 colony forming units, types of antibiotics received varied widely, and follow-up ranged from 10 days to 3 months. […] Data from 11 of the included RCTs (n = 1,308) showed LGG reduced the risk for antibiotic-associated diarrhea from 22.4% to 12.3% compared with placebo or no additional treatment (RR = 0.49; 95% CI, 0.29-0.83), although based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, the quality of this evidence was low. […] Moderate quality data from five of the included RCTs evaluating children (n = 445) showed the reduced risk for antibiotic-associated diarrhea (23% to 9.6%) was only significant in pediatric patients (RR = 0.48; 95% CI, 0.26-0.89). […] In summary, current evidence justified the use of LGG for preventing antibiotic-associated diarrhea, although a number of questions remain unanswered and the quality of evidence calls for caution, the researchers concluded.

• #2 Antibiotic-associated diarrhea – sboulardii – CNCM i-745

  https://www.saccharomycesboulardii.com/therapeutic-area/antibiotic-associated-diarrhea/

  The single-strain yeast probiotic Saccharomyces boulardii CNCM I-745 is proven to help reduce the occurrence of antibiotic-associated diarrhea.6 For example, it has been demonstrated that the occurrence of diarrhea is reduced by 53% in adults when Saccharomyces boulardii CNCM I-745 is taken at the same time as antibiotics.6 […] Unlike bacterial probiotics, S. boulardii CNCM I-745 is naturally resistant to antibiotics which means that it can be taken at the same time as antibiotics to act on the immediate effect of the antibiotics on the microbiota and reduce the risk of antibiotic-associated diarrhea.8

• #2 Feature Review: Probiotics for the prevention antibiotic-associated diarrhea in children | Cochrane

  https://www.cochrane.org/news/feature-review-probiotics-prevention-antibiotic-associated-diarrhea-children

  Antibiotic-associated diarrhea (AAD) occurs when antibiotics disturb the natural balance of „good” and „bad” bacteria in the intestinal tract, causing harmful bacteria to multiply beyond their normal numbers. […] Probiotics may restore the natural balance of bacteria in the intestinal tract and prevent AAD. […] Analyses showed that probiotics may be effective for preventing AAD in children. […] Probiotics were generally well tolerated, and minor side effects occurred infrequently, with no significant difference between probiotic and control groups. […] Among the various probiotics evaluated, Lactobacillus rhamnosus or Saccharomyces boulardii at a dosage of 5 to 40 billion colony forming units per day may be appropriate for preventing AAD in children receiving antibiotics. […] Our Cochrane Review looked at the results of 23 studies and found probiotics to be effective for preventing diarrhea that is brought on by antibiotics in children.

• #2 Probiotics for the prevention of antibiotic-associated diarrhoea: a systematic review and meta-analysis | BMJ Open

  https://bmjopen.bmj.com/content/11/8/e043054

  Probiotics for the prevention of antibiotic-associated diarrhoea: a systematic review and meta-analysis […] The pooled analysis suggests that co-administration of probiotics with antibiotics reduces the risk of AAD in adults by 37% (risk ratio (RR)=0.63 (95% CI 0.54 to 0.73), p0.00001). […] Probiotics are effective for preventing AAD. […] Secondary analyses of higher dosages and certain species have shown increased effectiveness. […] The principal finding of this review is that probiotics significantly reduce the risk of AAD in adults, with an NNT of 20 patients. […] Our results show evidence of a placebo effect, with a reduction in risk of AAD of 31% when probiotics were compared with placebo, but 65% when probiotics were compared with no treatment. […] In studies that compared dosage of the same probiotic, higher doses were found to be significantly more effective, suggesting a recommended dose of greater than 10 billion cfu per day. […] This review has demonstrated overall effectiveness of probiotics for the prevention of AAD, including a doseresponse and some species-specific effectiveness of probiotics.

• #2 The Effectiveness of Synbiotics in Preventing Antibiotic-Associated Diarrhea in Children: A Double-Blind Randomized Clinical Trial

  https://brieflands.com/articles/apid-89707

  The current study has shown that the use of synbiotics within 24 hours following the antibiotic therapy initiation caused a statistically fewer occurrence of AAD in the case group compared with the control group, and the logistic regression test shows that children who were not under synbiotic therapy were at 2.4 times higher risk of AAD in comparison to the case group. […] In summary, the findings of this study showed that early initiation of synbiotics and its long-term administration following antibiotic therapy cessation could considerably prevent antibiotic-associated diarrhea incidence. However, synbiotics use could not positively affect the duration, stool consistency, and frequency of defecation a day in AAD-affected patients.

• #2 Probiotics for the prevention of antibiotic-associated diarrhea in children | Cochrane

  https://www.cochrane.org/CD004827/IBD_probiotics-prevention-antibiotic-associated-diarrhea-children

  Evidence suggested that probiotics are effective for a moderate reduction in duration of diarrhea (almost one day). […] Among the various probiotics evaluated, Lactobacillus rhamnosus or Saccharomyces boulardii at 5 to 40 billion colony forming units/day appear most appropriate for preventing AAD in children receiving antibiotics. […] The overall evidence suggests a moderate protective effect of probiotics for preventing AAD (NNTB 9, 95% CI 7 to 13). […] Evidence also suggests that probiotics may moderately reduce the duration of diarrhea, a reduction by almost one day. […] Adverse event rates were low and no serious adverse events were attributable to probiotics. […] Common adverse events included rash, nausea, gas, flatulence, abdominal bloating, and constipation.

• #2

  https://www.racgp.org.au/clinical-resources/clinical-guidelines/handi/handi-interventions/nutrition/probiotics-for-the-prevention-of-antibiotic

  Probiotics for the prevention of antibiotic-associated diarrhoea in adults and children. […] There is some evidence that the benefits of probiotics are strain-specific. Lactobacillus rhamnosus GG and Saccharomyces boulardii appear to be the most efficacious choice for preventing antibiotic-associated diarrhoea, while Lactobacillus casei may be the best for specifically preventing severe C. difficile-related diarrhoea. […] To reduce risk of antibiotic-associated diarrhoea in those at higher risk. […] Longer duration of antibiotic use (3 days) is more likely to cause antibiotic-associated diarrhoea. […] Children aged 2 years and people who are frail or with co-morbid conditions may have a higher risk of antibiotic-associated diarrhoea than the general population. […] However, given its efficacy in prevention, the use of probiotics in AAD would be reasonable.

• #2 Probiotics for antibiotic-associated diarrhea: Do we have a verdict?

  https://www.wjgnet.com/1007-9327/full/v20/i47/17788.htm

  Probiotics use has increased tremendously over the past ten years. This was coupled with a surge of data relating their importance in clinical practice. Antibiotic-associated diarrhea, whose frequency has risen recently, was one of the earliest targets with data published more than ten years ago. […] Most published randomized controlled trials and subsequent meta-analyses suggest benefit for probiotics in the prevention of antibiotic-associated diarrhea. […] Probiotics have enjoyed an impeccable safety reputation. […] it would be advisable at this point to suggest prophylactic use of probiotics to certain patients at risk for antibiotic-associated diarrhea or to those who suffered previous episodes. […] The effectiveness of the use of probiotics in the prevention of AAD has been thoroughly examined in the past few years.

• #2

  https://journals.lww.com/jcge/fulltext/2008/07001/probiotics_for_prevention_of_antibiotic_associated.4.aspx

  Antibiotic-associated diarrhea (AAD) occurs in approximately 25% of patients receiving antibiotics. Probiotics are living microorganisms used to restore gut health by changing the intestinal microbiota. Several have been studied for the prevention of AAD. The results showed an overall reduction in the risk of AAD when probiotics were coadministered with antibiotics. More than half of the trials demonstrated efficacy of the probiotic. In particular, Lactobacillus GG, Saccharomyces boulardii, and the probiotic mixtures were effective. The per protocol pooled analysis, but not the intent-to-treat analysis, showed that probiotics are effective for preventing AAD with the number needed to treat to prevent 1 case of diarrhea being 10. Lactobacillus GG, Bacillus coagulans, and S. boulardii appeared to be most effective. Probiotics are generally safe, however, they should be used with caution in patients who have compromise of either the immune system or the integrity of the intestinal mucosa, and in the presence of a central venous catheter.

• #2 Antibiotics Diarrhea: Causes, Treatment, and Prevention

  https://www.healthline.com/health/antibiotics-diarrhea

  Antibiotic-associated diarrhea is fairly common. Its estimated that between 5 and 25 percent of adults may experience diarrhea while taking antibiotics. […] There are some steps that you can take to lower your risk of developing antibiotic-associated diarrhea. Some suggestions include: […] Try probiotics. Probiotics can help add good bacteria back into your digestive system. Some recent reviews of scientific literature have found that using probiotics while taking antibiotics can be effective for preventing diarrhea. […] Practice good hygiene. Washing your hands frequently, especially after using the bathroom, can help prevent the spread of C. diff bacteria. […] Follow medication instructions. Some antibiotics may say to take with food. Be sure to do this to help prevent digestive irritation.

• #2 Patient education: Antibiotic-associated diarrhea caused by Clostridioides difficile (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antibiotic-associated-diarrhea-caused-by-clostridioides-difficile-beyond-the-basics/print

  Antibiotic-associated diarrhea refers to diarrhea that develops in a person who is taking or recently took antibiotics. One of the most serious causes of antibiotic-associated diarrhea is infection with a bacterium called Clostridioides difficile. C. difficile infections are common, with approximately 500,000 cases per year in the United States. Infection is most common in people who are hospitalized, producing disease in more than 8 hospitalized patients per 1000 (0.9 percent) in 2008 in the United States. […] Hand washing is an effective way to prevent the spread of C. difficile. Hands should be washed after using the bathroom and before eating. Hands should ideally be wet with water and plain or antibacterial soap and rubbed together for 15 to 30 seconds. Special attention should be paid to the fingernails, between the fingers, and the wrists. Hands should be rinsed thoroughly and dried with a single-use towel. Patients and family members are encouraged to remind health care providers to wash their hands as well.

• #2 Probiotics for the Prevention of Pediatric Antibiotic-Associated Diarrhea

  https://www.drugtopics.com/view/probiotics-for-the-prevention-of-pediatric-antibiotic-associated-diarrhea

  The investigators concluded that the study provided no evidence to support the use of L reuteri for the prevention of AAD in children. […] The investigators found no statistically significant benefit for the probiotic and concluded that bovine lactoferrin was not effective for the prevention of AAD. […] The investigators concluded that the use of L rhamnosus GG significantly reduced the incidence and duration of AAD in children. […] A systematic review that assessed the results of 33 randomized, controlled studies concluded that probiotics produced a moderate reduction in the incidence of pediatric AAD, with a larger effect noted with high-dose probiotics ( 5 billion CFUs/day). […] Among the various probiotics evaluated, L rhamnosus (eg, Culturelle) or S boulardii (eg, Florastor) at 5 to 40 billion CFUs per day appeared to be most appropriate for preventing AAD in children. […] Notably, there does not seem to be a consensus concerning the use of probiotics to prevent AAD in children as a standard of care. When making recommendations concerning the use of probiotics, pharmacists should follow evidence-based practices.

• #2 Synbiotic for Prevention of Antibiotic-Associated Diarrhea in Children: A Randomized Clinical Trial

  https://jpp.mums.ac.ir/article_2121.html

  Antibiotic- associated diarrhea is a common problem in pediatric population. There is growing interest in probiotics, probiotics and synbiotics for prevention of this complication because of their worldwide availability as dietary supplements. The aim of this study was to assess the efficacy of a synbiotic mixture in prevention of antibiotic- associated diarrhea. […] This synbiotic mixture did not appear to reduce antibiotic- associated diarrhea in children. Further studies are needed to investigate the potential benefits of Synbiotics in prevention of this disease. […] The main objective was to evaluate the efficacy of the synbiotic in prevention of antibiotic associated diarrhea (at least 3 loose stools per day during 2 weeks after starting the antibiotic). […] As mentioned, in this study synbiotic had no significant effect on minimizing diarrhea, loose stool or stool frequency.

• #2 Travelers’ Diarrhea | Yellow Book | CDC

  https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/travelers-diarrhea

  Older controlled studies showed that use of antibiotics reduced diarrhea attack rates by 90%. For almost all travelers, though, the risks associated with the use of prophylactic antibiotics, including side effects, Clostridioides difficile infection, and increased risk of carriage of antimicrobial-resistant bacteria, do not outweigh the benefits. Prophylactic antibiotics might rarely be considered for short-term travelers who are high-risk hosts (e.g., immunocompromised people or people who have significant medical comorbidities). […] Prophylactic antibiotics are not recommended for most travelers. Prophylactic antibiotics afford no protection against nonbacterial pathogens and can remove normally protective microflora from the bowel, increasing the risk for acquisition of resistant bacterial pathogens.

• #2 Antibiotic-Associated Diarrhea – Canadian Digestive Health Foundation

  https://cdhf.ca/en/antibiotic-associated-diarrhea/

  Antibiotic-associated diarrhea (AAD) is a common complication of antibiotic treatment. It refers to the passage of loose, watery stool, at least three times per day, in individuals who are taking or recently took antibiotics (Kelly & Lamont, 2021; Gianelli 2017). […] Most cases of AAD are mild, requiring no further treatment. However, sometimes a more serious type of AAD can occur which is caused by the bug (bacterium) Clostridioides difficile, also known as C. diff for short (Barbut & Meynard, 2002). […] Here are some strategies to adopt if you have diarrhea: Hydration: Drink plenty of fluids containing adequate amounts of water, sugar and salts to stay hydrated. It is important to counteract the fluid and electrolyte lost though diarrhea. […] Contact your health care provider: If you have mild diarrhea, your symptoms will generally clear up once the antibiotic therapy is completed. However, in some cases your doctor may decide to stop the antibiotic until symptoms resolve.

• #2 Can Antibiotics Cause Diarrhea? Symptoms, Treatment, and Prevention Tips

  https://www.everydayhealth.com/digestive-health/can-antibiotics-cause-diarrhea/

  Research shows that probiotics help to prevent antibiotic-associated diarrhea in both children and adults. […] To replenish fluids, drink more clear liquids (water, broth) and drinks that contain electrolytes, such as a sports drink or oral rehydration solution. […] While there’s no specific diet for diarrhea, it’s best to eat foods that are gentle on your stomach, like bananas, rice, baked potato, toast, or crackers. Foods that contain probiotics, like Greek yogurt, can help to reset the correct balance of good-to-bad bacteria in your gut. […] To help prevent antibiotic-associated diarrhea, take antibiotics only when absolutely necessary to treat a bacterial infection, and eat foods rich in probiotics or take a supplement. […] Manage diarrhea by getting plenty of fluids and electrolytes, and eating a bland diet until this symptom resolves.

• #2 How to Prevent Diarrhea While You Take Antibiotics

  https://health.clevelandclinic.org/how-to-prevent-diarrhea-while-you-take-antibiotics

  When you need to take antibiotics to treat a bacterial infection, the last thing you want to do is add more symptoms into the mix. […] Diarrhea is a common concern. […] But when you truly do need to take them to fight an infection, you can also take steps to prevent or minimize diarrhea and other stomach problems. […] The thing that has really been shown to help the most with preventing diarrhea is taking probiotics when taking antibiotics, Dr. Rabovsky says. […] Probiotics come in several varieties. The most commonly studied for antibiotic-associated diarrhea are Lactobacillus rhamnosus-based and Saccharomyces boulardii-based probiotics. […] If spicy foods are normally a culprit for upset stomachs, avoid them when taking antibiotics. […] Its better to use caution than get hit with unpleasant side effects. […] Common sense would say you are going to disturb the natural balance with antibiotics, Dr. Rabovsky says, so anything else that causes you GI symptoms could make side effects even worse.

• #2 Antibiotic-Associated Diarrhea Beyond C. Difficile: A Scoping Review | Published in Journal of Brown Hospital Medicine

  https://bhm.scholasticahq.com/article/39745-antibiotic-associated-diarrhea-beyond-c-difficile-a-scoping-review

  The first-line treatments for AAD are discontinuation of the offending antibiotic and supportive care including maintaining adequate hydration. […] Fecal microbial therapy (FMT) should be considered in patients with two or more recurrences to correct the disruption in microbiota caused by recurrent use of antibiotics. […] Because a majority of the AAD cases are due to altered intestinal microbiota, modulating the microbiota, and adopting preventive strategies such as diet, prebiotics, probiotics, and drugs may be ultimately necessary to ensure optimal health and favorable outcomes in disease prone individuals.

• #2 Probiotics for the Prevention of Antibiotic-Associated Diarrhea

  https://www.mdpi.com/2227-9032/10/8/1450

  Probiotics are a vast market filled with various strains with unspecified benefits. […] Probiotics have become quite accessible to the public, as one can find a source in most supermarkets, pharmacies, and supplement stores. […] The Canadian Agency for Drugs and Technologies in Health (CADTH) carried out an evaluation of probiotics for AAD in the pediatric population. […] A strong recommendation was made for the use of L rhamnosus GG and S. boulardii for preventing AAD in children. […] The American Gastroenterological Association (AGA) suggested the use of certain organisms such as S. boulardii, or combinations of strains, for example, L. acidophilus CL1285 and L. casei, for adults and children who are being treated with antibiotics. […] The potential to alter these microbial ecosystems offers great hope for new preventative treatment options for antibiotic-associated diarrhea and other gastrointestinal disorders. […] Several studies show benefits of the use of probiotics for AAD, but still call for large placebo-controlled trials to determine species and dose effectiveness for prevention.

• #2 Probiotics for antibiotic-associated diarrhea: Do we have a verdict?

  https://www.wjgnet.com/1007-9327/full/v20/i47/17788.htm

  The literature suggests that CDAD can occur after just one dose of antibiotics and may appear up to several weeks after completion of antibiotic therapy. […] The 2010 Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for the treatment of CDI do not recommend the use of probiotics for the prevention of CDAD due to lack of evidence and risk of blood stream infection. […] Their analysis of different probiotic strains and types showed benefit across the board regardless of the genus or species. […] The appeal of using probiotics comes clearly from their ready availability, low cost and acceptable known safety profile. […] With the current data at hand, it is difficult to draw any solid conclusion about the prophylactic use of probiotics in AAD. It would be reasonable to advise their use in some specific populations such as patients with a history of AAD or risk factors for the development of CDAD.

• #3 Antibiotic-Associated Diarrhea – Canadian Digestive Health Foundation

  https://cdhf.ca/en/antibiotic-associated-diarrhea/

  Antibiotic-associated diarrhea (AAD) is a common complication of antibiotic treatment. It refers to the passage of loose, watery stool, at least three times per day, in individuals who are taking or recently took antibiotics (Kelly & Lamont, 2021; Gianelli 2017). […] Most cases of AAD are mild, requiring no further treatment. However, sometimes a more serious type of AAD can occur which is caused by the bug (bacterium) Clostridioides difficile, also known as C. diff for short (Barbut & Meynard, 2002). […] Here are some strategies to adopt if you have diarrhea: Hydration: Drink plenty of fluids containing adequate amounts of water, sugar and salts to stay hydrated. It is important to counteract the fluid and electrolyte lost though diarrhea. […] Contact your health care provider: If you have mild diarrhea, your symptoms will generally clear up once the antibiotic therapy is completed. However, in some cases your doctor may decide to stop the antibiotic until symptoms resolve.

• #3 Probiotics for the prevention of antibiotic-associated diarrhoea: a systematic review and meta-analysis | BMJ Open

  https://bmjopen.bmj.com/content/11/8/e043054

  Probiotics for the prevention of antibiotic-associated diarrhoea: a systematic review and meta-analysis […] The pooled analysis suggests that co-administration of probiotics with antibiotics reduces the risk of AAD in adults by 37% (risk ratio (RR)=0.63 (95% CI 0.54 to 0.73), p0.00001). […] Probiotics are effective for preventing AAD. […] Secondary analyses of higher dosages and certain species have shown increased effectiveness. […] The principal finding of this review is that probiotics significantly reduce the risk of AAD in adults, with an NNT of 20 patients. […] Our results show evidence of a placebo effect, with a reduction in risk of AAD of 31% when probiotics were compared with placebo, but 65% when probiotics were compared with no treatment. […] In studies that compared dosage of the same probiotic, higher doses were found to be significantly more effective, suggesting a recommended dose of greater than 10 billion cfu per day. […] This review has demonstrated overall effectiveness of probiotics for the prevention of AAD, including a doseresponse and some species-specific effectiveness of probiotics.

• #3 Probiotics to Prevent Antibiotic-Associated Diarrhea in Children | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0301/od2.html

  1 in 6 did not develop antibiotic-associated diarrhea when receiving high-dose probiotics (especially those containing Saccharomyces boulardii and Lactobacillus rhamnosus) […] Studies have demonstrated that probiotics are safe and effective when used in conjunction with antibiotics for preventing antibiotic-associated diarrhea in otherwise healthy children. […] Analyses indicated that probiotics coadministered with antibiotics moderately reduced the incidence of antibiotic-associated diarrhea in this patient population compared with active alternative prophylaxis, placebo, and no treatment. […] High-dose probiotics (5 billion colony-forming units [CFUs] or more per day) were found to be superior in reducing the incidence of antibiotic-associated diarrhea compared with low-dose probiotics (less than 5 billion CFUs per day). […] The number needed to treat (NNT) with probiotics to prevent one case of antibiotic-associated diarrhea was 9, and the NNT improved to 6 when using high-dose probiotics (95% CI, 5 to 9).

• #4 Probiotics for Preventing Antibiotic-Associated Diarrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1200/od1.html

  Antibiotic-associated diarrhea was prevented in 1 out of 20 patients taking probiotics. […] There was a 5.1% reduction in antibiotic-associated diarrhea. […] AAD can occur in up to 35% of patients who receive antibiotics and is associated with higher health care costs and increased morbidity and mortality. […] Probiotics reduced the risk of AAD overall (13.7% vs. 18.8%; absolute risk difference = 5.1%; number needed to treat = 20; risk ratio [RR] = 0.63; 95% CI, 0.54 to 0.73; moderate-quality evidence). […] Probiotic use in patients at moderate (11% to 30%) and high (31% or greater) baseline risk of AAD demonstrated a significant overall reduction (RR = 0.61; 95% CI, 0.48 to 0.78, and RR = 0.55; 95% CI, 0.46 to 0.66, respectively). […] Despite significant limitations due to heterogeneity, this meta-analysis found that probiotics reduced the incidence of AAD with no observed serious adverse effects.

• #4 Probiotics as a possible treatment antibiotic-associated diarrhea in the ICU | Rho Chi Post

  https://rhochistj.org/RhoChiPost/probiotics-as-a-possible-treatment-antibiotic-associated-diarrhea-in-the-icu/

  Antibiotic-associated diarrhea (AAD) can occur due to antibiotics changing the elements of the gut and thereby, increasing an organisms inhabitance. Diarrhea is common in as many as 40% of critically ill patients. An even greater problem is Clostridium difficile (antibiotics-associated) becoming a leading cause of mortality in hospital-related infections. Probiotics help prevent C. difficile infection in small scale studies; however, the results are still unclear in large-scale studies. […] Studies have shown that probiotics are safe to use in AAD patients. Probiotic use in AAD patients has increased with access to over-the-counter products. After reviewing 16 studies and 3400 patients, a Cochrane Review determined Lactobacillus rhamnosus GG and S. boulardii to be effective probiotics in preventing ADD. In a single-center, randomized, double-blind, placebo-controlled dose-ranging study by Gao et al, hospitalized adult-patients were treated with a probiotic containing 50 billion colony-forming units of Lactobacillus. Patients that received two capsules daily had a lower incidence of AAD (15.5%) than patients who received only one capsule (28.8%) or placebo (44.1%).

• #5 Probiotics use for antibiotic-associated diarrhea: a pragmatic participatory evaluation in nursing homes | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-020-01297-w

  Antibiotic-associated diarrhea (AAD) occurs in 225% of nursing home residents, which may lead to dehydration, malnutrition, severe complications and hospitalizations. Research shows that probiotics can be effective and safe in reducing AAD. […] The number of episodes with AAD when using probiotics was significantly lower than when no probiotics was used (20% vs 36%; p=0,022, Chi-square). […] Successful implementation of probiotics demonstrated the prevention of AAD in nursing home residents. […] Overall, it appears that probiotic use may be beneficial in the prevention of AAD in all age groups, although not all types of probiotics seem to be equally effective in preventing AAD in older populations. […] The present PPE showed that this multispecies probiotics significantly reduced AAD in nursing home residents. […] In conclusion, successful implementation of probiotics demonstrated a reduction in the occurrence of AAD in nursing home residents.

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