TABLE 1.
Characteristics of Enrolled Studies
| References | Risk of Bias (Based on Cochrane Handbook) | Setting | Sample Size (Treatment Group; Placebo Group) | Mean Age/Range (Treatment Group; Placebo Group) | Diarrhea Definition | Antibiotic (s) | Time From Antibiotic to Probiotic, d | Probiotic Species | Dosage Per Day | Probiotic Duration (d) | Follow-up Period (From the Cessation of Antibiotics Treatment) |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Armuzzi et al18 | Low | Adults, asymptomatic | 30/30 | 40 | NR | H. pylori eradication | 0 | Lactobacillus GG | 1.2×1010 CFU | 14 d, AC†+7 | 3 wk |
| Thomas et al19 | Low | Adults, in-patient | 133/134 | 57.2/54.4 | Other definition | Various | 1 | Lactobacillus GG | 1×1010 CFU | 14 d | 1 wk |
| Cremonini et al20 | Low | Adults, asymptomatic | 63/20 | 18-61 | NR | H. pylori eradication | 0 | Lactobacillus GG, Saccharomyces boulardii, or the combination of L. acidophilus and Bifidobacterium lactis | 6×109, 5×109, or 5×109 CFU | 14 d, AC+7 | 3 wk |
| Nista et al21 | Unclear | Adults, asymptomatic | 54/52 | 46.0/43.0 | NR | H. pylori eradication | 0 | Bacillus clausii | 6×109 CFU | 14 d, AC+7 | 3 wk |
| Can et al22 | Unclear | Adults, in-patient | 73/78 | 25-50 | NR | Various | 2 | S. boulardii | 1×1010 CFU | Various, AC | 4 wk |
| Beausoleil et al23 | High | Adults, in-patient | 44/45 | 68.8/72.9 | WHO* | Various | 2 | A combination of L. acidophilus and L. casei | 2.5×1010 CFU for the first 2 days, 5×1010vCFU for the remaining days | Various, AC | 3 wk |
| Cindoruk et al24 | Unclear | adults | 62/62 | 45.82/47.56 | NR | H. pylori eradication | 0 | S. boulardii | 1000 mg | 14 d, AC | 6 wk |
| Hickson et al25 | Unclear | Adults, in-patient | 57/56 | 73.7/73.9 | Other definition | Various | 2 | A combination of L. casei, S. thermophilus and L. bulgaricus | 1.94×1010, 1.94×1010, and 1.94×109 CFU, respectively | Various, AC+7 | 4 wk |
| Bravo et al26 | High | Adults, out-patient | 41/45 | 49.78/50.98 | WHO* | Amoxicillin | 1 | S. boulardii | 1×1010 CFU | 12 d, AC+ at least 2 d | At least 11 d |
| Koning et al27 | Unclear | Adults, healthy volunteers | 19/19 | 25.5/28.2 | Other definition | Amoxycillin | 0 | A combination of B. bifidum, B. lactis, B. Longum, E. faecium, L. acidophilus, L. paracasei, L. plantarum, L. rhamnosus L. salivarius | 1×1010 CFU | 14 d, AC+7 | 8 wk |
| Wenus et al28 | Unclear | Adults, in-patient | 34/29 | 58.8/56.2 | Adjusted WHO† | Various | 3 | A combination of Lactobacillus GG L. acidophilus and Bifidobacterium | 2.50×1010, 2.50×109, and 2.50×1010 CFU, respectively | 14 d | 0 |
| Gao et al29 | Unclear | Adults, in-patient | 171/84 | 60/60 | WHO* | One of penicillin, cephalosporin, or clindamycin | 1.5 | A combination of L. acidophilus and L. casei | 5×1010 or 1×1011 CFU | Various, AC+5 | 26 d |
| Lonnermark et al30 | Unclear | Adults, in-patient, and out-patient | 80/83 | 47/43 | Adjusted WHO† | Various | 2 | L. plantarum | 1×1010 CFU | Various, AC+7 | 2 wk |
| Song et al31 | High | Adults, in-patient | 103/111 | 61/60 | Adjusted WHO† | Various | 2 | A combination of L. rhamnosus and L. acidophilus | 4×109 CFU | 14 d | 0 |
| Bekar et al32 | Unclear | Adults | 46/36 | 46/43 | NR | H. pylori eradication | 0 | A combination of Lactobacilli, lactic streptococci, yeasts, and acetic acid bacteria | 500 mL | 14 d, AC | 0 |
| Cimperman et al33 | High | Adults, in-patient | 13/10 | 42.8/63.6 | Adjusted WHO† | Various | 4 | L. reuteri | 2×108 CFU | 28 d | 2 wk |
| Manfredi et al34 | Low | Adults | 73/76 | 46.4/50.6 | NR | H. pylori eradication | 0 | A combination of L. acidophilus, L. bulgaricus, B. bifidum, and Streptococcus thermophilus | 2×109, 2×109, 1×109, and 2×109 CFU, respectively | 10 d, AC | 0 |
| Pozzoni et al35 | Low | Adults, in-patient | 106/98 | 79.9/78.5 | Other definition | Various | 2 | S. boulardii | 1×1010 CFU | Various, AC+7 | 12 wk |
| Allen et al36 | Low | Adults, in-patient | 1470/1471 | 77.2/77.0 | WHO* | Various | 7 | A combination of L. acidophilus, B. bifidum and B. lactis | 6×1010 CFU | 21 d | 5 wk |
| Chatterjee et al37 | Low | Adults, out-patient | 176/167 | 18-70 | Adjusted WHO† | One of cefadroxil or amoxycillin | 0 | A combination of L. acidophilus and Bifidobacterium | 4×109 CFU | 14 d, AC+7 | 1 wk |
| Padilla et al38 | Unclear | Adults | 29/30 | 56.6 | NR | H. pylori eradication | 0 | L. rhamnosus | 1.2×1010 CFU | 7 d, AC | 0 |
| Selinger et al39 | Unclear | Adults, in-patient | 117/112 | 57.9/57.0 | Other definition | Various | 2 | A combination of B. breve, B. longum, B. infantis, L. acidophilus, L. plantarum, L. paracasei, L. delbrueckii subsp. Bulgaricus and Streptococcus thermophilus | 9×1011 CFU | Various, AC+7 | 4 wk |
| Shavakhi et al40 | Low | Adults | 90/90 | 42.3/42.2 | NR | H. pylori eradication | 0 | A combination of L. casei, L. rhamnosus, L. acidophilus, and L. bulgaricus, B. breve and B. longum, and Streptococcus thermophiles | 2×108 CFU | 14 d, AC | 4 wk |
| Francavilla et al41 | Low | Adults, dyspepsia | 44/43 | 49/44 | NR | H. pylori eradication | 0 | A combination of 2 strains of L. reuteri | 2×108 CFU | 7 d, AC | 61 d |
| Ouwehand et al42 | Low | Adults, in-patient | 336/167 | 49.9/50.0 | WHO* | One of broad-spectrum penicillin, cephalosporin, or clindamycin | 1.5 | A combination of L. acidophilus, L. paracasei and B. lactis | 4.17×109 or 1.70×1010 CFU | 10-21 d, AC+7 | 4 wk |
| Helps et al43 | Low | Adults, in-patient | 44/41 | 62.27/62.49 | WHO* | Various | 2 | L. casei, Shirota | 1.3×1010 CFU | Various, AC+7 | 12 wk after recruitment |
| Wright et al44 | Low | Adults, in-patient | 41/46 | 85.4/86.1 | Adjusted WHO† | Various | NA | L. casei, Shirota | 130 mL | Various, AC | 4 wk after recruitment |
| Ehrhardt et al45 | Unclear | Adults, in-patient | 246/231 | 60.1/56.5 | WHO* | Various | 2 | S. boulardii | 3.6×1010 CFU | Various but <8 wk, AC+7 | 7 wk |
| Evans et al46 | Low | Adults, healthy volunteers | 80/80 | 34.6/33.9 | Other definition | Amoxicillin-clavulanic acid | 0 | A combination of L. helveticus and L. rhamnosus | 0·4×109 and 7.6×109 CFU, respectively | 14 d, AC+7 | 8 wk |
| Shafaghi et al47 | High | Adults | 38/38 | 43.75/43.35 | NR | H. pylori eradication | 3 | A combination of L. casei, L. rhamnosus, Streptococcus thermophilus, B. breve, L. acidophilus, B. longum, L. bulgaricus | 4×108 CFU | 17 d, 3 days earlier+AC | 1 wk |
| Chotivitayatarakorn et al48 | Unclear | Adults, dyspepsia | 54/54 | 54.15 | NR | H. pylori eradication | 0 | S. boulardii | 565 mg | 7 or 14 d, AC | 2-3 wk |
| Haghdoost et al49 | Unclear | Adults, dyspepsia | 88/88 | 28.34 | NR | H. pylori eradication | 0 | A combination of L. actobacillus and Bifidobacterium | 3×109 CFU | 38 d, AC+28 | 10 wk |
| Jiang and Zhu50 | Unclear | Adults | 111/111 | 35.2/34.8 | NR | H. pylori eradication | 0 | Bifidobacterium | 6 capsules | 14 d, AC | 4 wk |
| Trallero et al51 | Unclear | Adults | 18/18 | 38.5 | Other definition | Amoxicillin-clavulanic acid | 0 | A combination of L. acidophilus, L. rhamnosus, B. breve, B. longum, B. lactis and B. bifidum | 1×109 CFU | 30 d, AC+22 | 22 d |
| Romeo et al52 | Unclear | Adults | 74/73 | 18-65 | WHO* | Amoxicillin/clavulanic acid | 0 | Combination including Lactobacillus GG | Unclear | 7 d, AC | 0 |
| Rajkumar et al53 | Unclear | Adults, in-patient | 549/577 | 73.7/73.5 | Other definition | Various | 2 | A combination of L. casei, L. delbrueckii subspecies bulgaricus and S. thermophilus | 2×1010, 2×108, and 2×108 CFU, respectively | Various, AC+7 | 3 wk |
*
WHO, diarrhea was defined as ≥3 loose stools within a 24-hour period.
†
Adjusted WHO, diarrhea was defined as ≥3 loose stools/day for at least 2 days.
AC indicates antibiotic course; NR, not reported; WHO, World Health Organization.