| Article |
Design |
Study population |
Results/outcome |
| Cai et al. [8] |
Meta-analysis |
51 RCTs comparing 10 probiotic interventions. |
On prevention of AAD, L. rhamnosus GG (LGG) had the highest probability of being ranked best both in effectiveness (odds ratio (OR)), 95% confidence interval (CI). 0.28 (0.17, 0.47)) and tolerance (0.44 (0.23, 0.84)). L. casei also had better efficacy (0.04(0.00, 0.77)) in reducing CDI rate. |
| Ripert et al. [10] |
Meta-analysis |
Studied the ability of the compounds secreted by the probiotic B. clausii to counteract the toxins produced by two pathogens: clostridium difficile and B. cereus
|
The probiotic formulation containing these three Lactobacilli strains (L. acidophilus CL1285, L. casei LBC80R, L. rhamnosus CLR2, Bio-K) is the most efficacious probiotic combination. |
| Videlock et al. [11] |
Meta-analysis |
4138 patients from 34 RCTs |
Significant prevention of AAD in the probiotic group versus the placebo at a pooled RR of 0.53 (95% CI 0.44-0.63) |
| Fox et al. [12] |
RCT |
Children were randomly given 200 g/day of either yogurt containing L. rhamnosus, B. lactis-12, and L. acidophilus La-5 or placebo |
No evidence of severe diarrhea in the probiotic group and 6 in placebo. |
| Sampalis et al. [13] |
RCT |
214 randomized to Bio-K and 221 to placebo in a hospital setting |
Incidence of diarrhea was 21.8% in Bio-K + CL1285 group versus 29.4% in the placebo group, adjusted OR=0.627, p=0.037, showing significant efficacy of L. acidophilus CL. Mechanisms: modulation of intestinal cytokine production, esp., inflammatory cytokines |
| Sniffen et al. [14] |
Meta-analysis |
Analyzed 249 trials that showed evidence for 22 different types of probiotics |
L. casei DN1114001 had 2 RCTs with significant findings, 0 RCTs with non-significant findings. S. boulardii I-745 had 18+ versus 9- |
| Blaabjerg et al. [15] |
Meta-analysis |
217 RCTs with 3631 participants randomized to either the L. rhamnosus
S. boulardii treatment group or placebo |
Found an incidence of AAD in 8.0% of the probiotic group compared to 17.7% in the control group (RR 0.49, 95% CI 0.36 to 0.66) |
| Alberda et al. [16] |
RCT |
32 patients participated |
AAD was documented in 12.5% of the probiotic group and 31.3% in the control group, providing evidence of the efficacy of L. casei drink |
| Dietrich et al. [17] |
Non-randomized prospective cohort |
Two L. casei strain drinks were directly compared in 60 patients in an RCT |
AAD significantly reduced in the intervention group (6.7% versus 33.3%; p<0.021) that had the L. casei DN114001 than the group with the L. casei Shirota drink |
| Szajewska et al. [18] |
Meta-analysis |
4780 patients from 21 RCTS |
S. boulardii treatment reduced AAD incidence (8.5% versus 18.7%; RR: 0.47; 95% CI: 0.38-0.57) compared to the placebo |
| McFarland [19] |
Meta-analysis |
27 RCTS encompassing 5029 patients |
S. boulardii had a significant therapeutic efficacy in 84% of the treatment arms in the prevention of AAD (RR=0.47, 95% CI: 0.35-0.63, p <0.001) |
| Thygesen et al. [20] |
Case report |
A 79-year-old woman treated with antibiotics and S. boulardii (Sacchaflor) |
The patient developed fungemia 13 days after treatment |
| Yun et al. [21] |
Prospective cohort |
Co-cultured Bifidobacterium with C. difficile
|
The survival rates for mice given B. longum ATCC 15707 alone, and with live cells, or dead cells of B. longum were 40%, 70%, and 60%, respectively. |
| Patrone et al. [22] |
Prospective cohort without controls |
Bacterial enumeration from three batches was carried out by plating techniques |
Of the five brand names/commercial products for the B. clausii in India and Pakistan, only Enterogermina tends to follow the label claim of efficacy of the B. clausii for AAD prevention |
| Lakshmi et al. [23] |
Prospective cohort with no controls |
Rats exposed to B. clausii for acute toxicity |
Showed significant efficacy in B. clausii use against AAD and its safety |
| Chatterjee et al. [24] |
RCT without controls |
Adults randomized to combined L. acidophilus CL and Bifidobacterium spp |
AAD incidence in only 10.8% of the group randomized to a combined Bifidobacterium spp and L. acidophilus CL compared to 15.6% in the placebo group (RR: 0.7; 95% CI 0.4-1.2) |
| Valdés-Varela et al. [25] |
Case control |
Analyzed the capacity of twenty Bifidobacterium and Lactobacillus strains with C. difficile
|
Compared the efficacy of Bifidobacterium vs. Lactobacillus strains: B. longum IPLA20022 showed the highest ability to counteract the cytotoxic effect of C. difficile, LMG21717 |
| Valdés-Varela et al. [26] |
Prospective cohort |
Co-cultured a toxogenic C. difficile with 4 Bifidobacterium strains |
B. longum and B. breve were the strains showing a higher reduction in the toxicity of the co-culture supernatants |
| Cameron et al. [27] |
Meta-analysis |
Meta-analysis of 249 RCTs |
The following strains were recommended for AAD prevention: S. boulardii I-745, L. casei DN114001, and LaLcLr mix (a combination of L. acidophilus CL1285, L. casei Lbc80r, and L. rhamnosus CLR2) for AAD prevention in any age group |
| Song et al. [28] |
RCT |
214 patients were randomized to either a Lactobacillus capsule or placebo for 14 days |
Lactobacillus strains prevent AAD through modification of toxin receptors, competition for nutrients, competitive inhibition of pathogen adhesion, and the synthesis of antimicrobial substances |
