Meta–but not the final–analysis of efficacy of probiotics in prevention of antibiotic-associated diarrhea

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The meta-analysis performed by Szajewska et al included only placebo-controlled, randomized clinical trials of efficacy of probiotics in preventing antibiotic-associated diarrhea in children. The expected quality of the studies and findings, therefore, would be high. The authors point out that unfortunately, precision of definition of diarrhea, the classes of antibiotics used, the species of probiotic microorganism used were heterogeneous across studies. Although the use of probiotics was associated with relative risk of 0.44 (95% confidence interval 0.25 to 0.77) for antibiotic associated diarrhea, there are several caveats of study design that preclude their definitive recommendation. Larger, better studies are necessary to form the evidence before the next metaanalysis can be performed, which conclusion could guide optimal clinical care.