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

Table 4 Outcomes for 22 clinical trials of pediatric antibiotic-associated diarrhea and Clostridium difficile infections trials (total 23 treatment arms)

Probiotic strain	Attrit-ion	ITT orAPP	Incidence A-AD probiotic	Incidence AADcontrols	P value(% power)	IncidenceCDIprobiotic	Incidence CDIcontrols	P value(% power)	Ref.
S. boulardii lyo	21%	APP	25/327 (7.6%)	16/289 (5.5%)	0.29	--	--	--	Benhamou et al[30], 1999
					14%
S. boulardii lyo + SAM	29%	APP	7/117 (5.7%)	30/117 (25.6%)	< 0.001	--	--	--	Erdeve et al[34], 2004
					98%
S. boulardii lyo + AZT	29%	APP	7/127 (5.5%)	12/105 (11.4%)	0.15	--	--	--	Erdeve[34], 2004
					29%
S. boulardii lyo	8.60%	APP	9/119 (8.0%)	29/127 (23.0%)	0.001	3/119 (2.5)	10/127 (7.9%)	0.09	Kotowska et al[36], 2005
					87%			36%
S. boulardii lyo	15%	APP	6/139 (4.3%)	28/144 (19.4%)	< 0.001	1/139 (0.7%)	8/144 (5.6%)	0.04	Shan et al[43], 2014
					96%			42%
L. rhamnosus GG	0%	ITT	6/23 (26%)	8/36 (22%)	0.76	--	--	--	Vaisanen et al[47], 1998
					3%
L. rhamnosus GG	28.70%	APP	3/61 (5%)	9/58 (16%)	0.07	1/61 (1.6%)	1/58 (1.7%)	1	Arvola et al[29], 1999
					38%			10%
L. rhamnosus GG	6.90%	APP	7/93 (7.5%)	25/95 (26%)	0.001	--	--	--	Vanderhoof et al[48], 1999
					90%
L. rhamnosus GG	20%	ITT	2/34 (6%)	6/30 (20%)	0.13	--	--	--	Szajewska[44], 2009
					26%
L. sporogenes [Bac. sporogenes] + FOS	18%	ITT	14/48 (29%)	31/50 (62%)	0.001	--	--	--	La Rosa et al[37], 2003
					88%
C. butyricum MIYAIRI	Nr	Nr	6/86 (7%)	16/27 (59%)	< 0.001	0/86	0/27	--	Seki et al[42], 2003
					99%
L. acidophilus	Nr	Nr	10/215 (4.6%)	30/139 (21.6%)	< 0.001	--	--	--	Pancheva-Dimitrova et al[39], 2004
					99%
B. clausii	0%	ITT	3/162 (1.8%)	7/161 (4.3%)	0.22	0/162 (0%)	1/161 (0.6%)	0.5	Destura et al[33], 2008
					16%			3%
Mixes
L. acidophilus +L. bulgaricus	37%	APP	10/15 (66%)	16/23 (69.5%)	1	--	--	--	Tankanow et al[46], 1990
					3%
L. acidophilus +Bifido infantis	0%	ITT	3/8 (37.5%)	8/10 (80%)	0.14	--	--	--	Jirapinyo et al[35], 2002
					25%
Bifido lactis + Strept thermophilus	7.10%	APP	13/80 (16%)	24/77 (31.2%)	0.04	--	--	--	Corrêa et al[32], 2005
					54%
Bifido longum PL03 + L. rhamnosus KL53A + L. plantarum PL02	0%	ITT	1/40 (2.5%)	2/38 (5.3%)	0.61	--	--	--	Szymański et al[45], 2008
					3%
L. rhamnosus (3 strains) E/N, Pen and Oxy	1.20%	ITT	9/120 (7.5%)	20/120 (17%)	0.046	3/120 (2.5%)	7/120 (5.8%)	0.33	Ruszczyński et al[40], 2008
					53%			16%
Kefir (mix of 9 strains)	6.40%	ITT	11/61 (18%)	14/64 (21.9%)	0.66	--	--	--	Merenstein et al[38], 2009
					5%
C. butyricum +Bifido. infantis	2.10%	APP	15/193 (7.8%)	30/179 (16.8%)	0.01	--	--	--	Investigating Group for Prevention of AAD in Children with Pneumonia by Clostridium Butyricum and Bifidobacterium[49], 2012
					70%
Bifido animalis +L. acidophilus + Strept thermophilus	12%	ITT	2/48 (4%)	3/34 ( 9%)	0.64	--	--	--	Conway et al[31], 2007
					8%
L. casei + L. acidophilus + L. reuteri + L. bulgaricus + Strept. cremoris + Bifido. bifidum + Bifido. infantis + FOS	0%	ITT	3/25 (12%)	13/25 (52%)	0.005	--	--	--	Saneeyan et al[41], 2011
					80%
L. casei + L. rhamnosus + L. bulgaricus + L. acidophilus + Strept. thermophilus + Bifido. breve + Bifido. infantis	0%	ITT	2/33 (6.1%)	8/33 (24.2%)	0.04	--	--	--	Ahmad et al[28], 2013
					40%

AAD: Antibiotic-associated diarrhea; CDI: Clostridium difficile disease; S. boulardii: Saccharomyces boulardii; L. rhamnosus: Lactobacillus rhamnosus; Nr: Not reported.