AIM:To investigate the effect of Lactobacillus-containing commercially available probiotic formulations in Germany during antibiotic treatment with an analysis of cost-efficiency.METHODS:In an observational study,we a...AIM:To investigate the effect of Lactobacillus-containing commercially available probiotic formulations in Germany during antibiotic treatment with an analysis of cost-efficiency.METHODS:In an observational study,we analyzed the frequency of bowel movements from 258 patients with infections in a primary care hospital in western Germany;107 of the patients were offered a probiotic drink containing at least 10 billion cultures of Lactobacillus casei DN 114001 b.i.d.The economic analysis was based on the costs of patient isolation vs preventive intake of probiotics.In a second pilot study,two commercially available probiotic drinks with different Lactobacillus casei strains were directly compared in 60patients in a randomized controlled fashion.RESULTS:In the first study,the incidence of antibioticassociated diarrhea(AAD)was significantly reducedin the intervention group(6.5%vs 28.4%),and the duration of AAD in days was significantly shorter(1.7±1.1 vs 3.1±2.1).Higher age and creatinine and lower albumin were identified as risk factors for AAD.Ampicillin was the antibiotic with the highest rate of AAD(50%)and with the greatest AAD reduction in the probiotic group(4.2%,relative risk reduction 92%).The economic analysis showed a cost advantage of nearly60000€/year in a department of this size.The second study confirmed the preventive effect of the drink with Lactobacillus casei DN114001;however,there were no advantages found for the other tested probiotic drink containing Lactobacillus casei Shirota.CONCLUSION:In contrast to a drink containing Lactobacillus casei Shirota,a commercially available probiotic drink containing Lactobacillus casei DN 114001 costefficiently reduces the prevalence of AAD during antibiotic treatment.展开更多
Probiotics use has increased tremendously over the past ten years.This was coupled with a surge of data relating their importance in clinical practice.Antibioticassociated diarrhea,whose frequency has risen recently,w...Probiotics use has increased tremendously over the past ten years.This was coupled with a surge of data relating their importance in clinical practice.Antibioticassociated diarrhea,whose frequency has risen recently,was one of the earliest targets with data published more than ten years ago.Unfortunately,available trials suffer from severe discrepancies associated with variability and heterogeneity of several factors.Most published randomized controlled trials and subsequent meta-analyses suggest benefit for probiotics in the prevention of antibiotic-associated diarrhea.The same seems to also apply when the data is examined for Clostridium difficile-associated colitis.However,the largest randomized double-blind placebo-controlled trial to date examining the use of a certain preparation of probiotics in antibiotic-associated diarrhea showed disappointing results,but it was flawed with several drawbacks.The commonest species of probiotics studied across most trials is Lactobacillus;however,other types have also shown similar benefit.Probiotics have enjoyed an impeccable safety reputation.Despite a few reports of severe infections sometimes leading to septicemia,most of the available trials confirm their harmless behavior and show similaradverse events compared to placebo.Since a consensus dictating its use is still lacking,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.展开更多
AIM: To assess the efficacy and safety of probiotics for preventing pediatric:(1) antibiotic associated diarrhea and(2) Clostridium difficile(C. difficile) infections.METHODS: On June 3, 2013, we searched Pub Med(1960...AIM: To assess the efficacy and safety of probiotics for preventing pediatric:(1) antibiotic associated diarrhea and(2) Clostridium difficile(C. difficile) infections.METHODS: On June 3, 2013, we searched Pub Med(1960-2013), EMBASE(1974-2013), Cochrane Database of Systematic Reviews(1990-2013), CINAHL(1981-2013), AMED(1985-2013), and ISI Web of Science(2000-2013). Additionally, we conducted an extensive grey literature search including contact with National Institutes of Health Clinical Trials Registry, abstracts from annual infectious disease and gastroenterology meetings, experts in the field and correspondence with authors. The primary outcomes were the incidence of antibiotic-associated diarrhea(AAD) and C. difficile infections(CDI). Dichotomous outcomes(e.g., incidence of AAD or CDI) were pooled using a random-effects model to calculate the relative risk and corresponding 95% confidence interval(95%CI) and weighted on study quality. To explore possible explanations for heterogeneity, a priori subgroup analysis were conducted on probiotic strain type, daily dose, quality of study and safety of probiotics. The overall quality of the evidence supporting each outcome was assessed using the grading of recommendations, assessment, development and evaluation criteria.RESULTS: A total of 1329 studies were identified with 22 trials(23 treatment arms and 4155 participants) meeting eligibility requirements for our review of prevention of AAD and 5 trials(1211 participants) for the prevention of CDI. Trials in adult populations, trials of uncertain antibiotic exposure or studies which did not provide incidence of AAD were excluded. We found 12 trials testing a single strain of probiotic and 10 trials testing a mixture of probiotic strains. Probiotics(all strains combined) significantly reduced the incidence of pediatric AAD(pooled RR = 0.42, 95%CI: 0.33-0.53) and significantly reduced pediatric CDI(pooled RR = 0.35, 95%CI: 0.13-0.92). Of the two strains with multiple trials, both significantly reduced pediatric AAD: Saccharomyces boulardii lyo(pooled RR = 0.43, 95%CI: 0.32-0.60) and Lactobacillus rhamnosus GG(pooled RR = 0.36, 95%CI: 0.19-0.69). There was no significant effect by type of antibiotic, or by duration or dose of probiotic. No adverse events associated were found in the 22 controlled trials relating to the use of probiotics.CONCLUSION: This meta-analysis found that probiotics significantly prevented pediatric antibiotic associated diarrhea and pediatric CDI, but the efficacy varies significantly by the strain of the probiotic.展开更多
目的:基于网状Meta分析,评价不同中药联合益生菌治疗抗生素相关性腹泻(AAD)的疗效及安全性,为临床安全用药方案提供循证医学依据。方法:在万方数据库、维普数据库、中国知网、中华医学期刊数据库、PubMed、Web of Science等数据库中检...目的:基于网状Meta分析,评价不同中药联合益生菌治疗抗生素相关性腹泻(AAD)的疗效及安全性,为临床安全用药方案提供循证医学依据。方法:在万方数据库、维普数据库、中国知网、中华医学期刊数据库、PubMed、Web of Science等数据库中检索中药联合益生菌治疗AAD的随机对照试验(观察组干预措施为中药联合益生菌,对照组干预措施为单纯使用益生菌),检索时间截至2023年1月。采用贝叶斯网状Meta分析方法,对不同中药联合益生菌治疗AAD的安全性和有效性进行评价。结果:筛选出21篇随机对照试验文献,涉及患者2 093例;使用的中药包括健脾补肾固摄汤、人参败毒散或健脾止泻汤、四逆汤联合四神汤、参术止泻汤、乌梅丸、巴特日-7味丸、胃肠安丸、参苓白术颗粒(参苓白术散)、小儿腹泻散、参苓白术散+补肺汤、醒脾养儿颗粒、儿泻停颗粒、黄芪建中汤、马齿苋煎煮液、固本益肠片共15种。以总有效率为基础指标进行贝叶斯网状Meta分析,结果显示,人参败毒散或健脾止泻汤的效果最佳(OR=12,95%CI=3.1~78.0),且差异有统计学意义(P<0.05)。结论:文献研究前后患者的身体指标未见异常,15种中药联合益生菌治疗AAD的研究方案未对患者造成伤害;同时在鼠类的AAD模型复现上也得到了相应的证实,可以认为本次网状Meta分析的结果是安全、可靠的。本研究中的中药联合益生菌治疗AAD的疗效均优于单纯使用益生菌,能有效缩短病程,为临床用药提供了循证医学证据,但仍需要更多的研究支持和验证。展开更多
文摘AIM:To investigate the effect of Lactobacillus-containing commercially available probiotic formulations in Germany during antibiotic treatment with an analysis of cost-efficiency.METHODS:In an observational study,we analyzed the frequency of bowel movements from 258 patients with infections in a primary care hospital in western Germany;107 of the patients were offered a probiotic drink containing at least 10 billion cultures of Lactobacillus casei DN 114001 b.i.d.The economic analysis was based on the costs of patient isolation vs preventive intake of probiotics.In a second pilot study,two commercially available probiotic drinks with different Lactobacillus casei strains were directly compared in 60patients in a randomized controlled fashion.RESULTS:In the first study,the incidence of antibioticassociated diarrhea(AAD)was significantly reducedin the intervention group(6.5%vs 28.4%),and the duration of AAD in days was significantly shorter(1.7±1.1 vs 3.1±2.1).Higher age and creatinine and lower albumin were identified as risk factors for AAD.Ampicillin was the antibiotic with the highest rate of AAD(50%)and with the greatest AAD reduction in the probiotic group(4.2%,relative risk reduction 92%).The economic analysis showed a cost advantage of nearly60000€/year in a department of this size.The second study confirmed the preventive effect of the drink with Lactobacillus casei DN114001;however,there were no advantages found for the other tested probiotic drink containing Lactobacillus casei Shirota.CONCLUSION:In contrast to a drink containing Lactobacillus casei Shirota,a commercially available probiotic drink containing Lactobacillus casei DN 114001 costefficiently reduces the prevalence of AAD during antibiotic treatment.
文摘Probiotics use has increased tremendously over the past ten years.This was coupled with a surge of data relating their importance in clinical practice.Antibioticassociated diarrhea,whose frequency has risen recently,was one of the earliest targets with data published more than ten years ago.Unfortunately,available trials suffer from severe discrepancies associated with variability and heterogeneity of several factors.Most published randomized controlled trials and subsequent meta-analyses suggest benefit for probiotics in the prevention of antibiotic-associated diarrhea.The same seems to also apply when the data is examined for Clostridium difficile-associated colitis.However,the largest randomized double-blind placebo-controlled trial to date examining the use of a certain preparation of probiotics in antibiotic-associated diarrhea showed disappointing results,but it was flawed with several drawbacks.The commonest species of probiotics studied across most trials is Lactobacillus;however,other types have also shown similar benefit.Probiotics have enjoyed an impeccable safety reputation.Despite a few reports of severe infections sometimes leading to septicemia,most of the available trials confirm their harmless behavior and show similaradverse events compared to placebo.Since a consensus dictating its use is still lacking,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.
文摘AIM: To assess the efficacy and safety of probiotics for preventing pediatric:(1) antibiotic associated diarrhea and(2) Clostridium difficile(C. difficile) infections.METHODS: On June 3, 2013, we searched Pub Med(1960-2013), EMBASE(1974-2013), Cochrane Database of Systematic Reviews(1990-2013), CINAHL(1981-2013), AMED(1985-2013), and ISI Web of Science(2000-2013). Additionally, we conducted an extensive grey literature search including contact with National Institutes of Health Clinical Trials Registry, abstracts from annual infectious disease and gastroenterology meetings, experts in the field and correspondence with authors. The primary outcomes were the incidence of antibiotic-associated diarrhea(AAD) and C. difficile infections(CDI). Dichotomous outcomes(e.g., incidence of AAD or CDI) were pooled using a random-effects model to calculate the relative risk and corresponding 95% confidence interval(95%CI) and weighted on study quality. To explore possible explanations for heterogeneity, a priori subgroup analysis were conducted on probiotic strain type, daily dose, quality of study and safety of probiotics. The overall quality of the evidence supporting each outcome was assessed using the grading of recommendations, assessment, development and evaluation criteria.RESULTS: A total of 1329 studies were identified with 22 trials(23 treatment arms and 4155 participants) meeting eligibility requirements for our review of prevention of AAD and 5 trials(1211 participants) for the prevention of CDI. Trials in adult populations, trials of uncertain antibiotic exposure or studies which did not provide incidence of AAD were excluded. We found 12 trials testing a single strain of probiotic and 10 trials testing a mixture of probiotic strains. Probiotics(all strains combined) significantly reduced the incidence of pediatric AAD(pooled RR = 0.42, 95%CI: 0.33-0.53) and significantly reduced pediatric CDI(pooled RR = 0.35, 95%CI: 0.13-0.92). Of the two strains with multiple trials, both significantly reduced pediatric AAD: Saccharomyces boulardii lyo(pooled RR = 0.43, 95%CI: 0.32-0.60) and Lactobacillus rhamnosus GG(pooled RR = 0.36, 95%CI: 0.19-0.69). There was no significant effect by type of antibiotic, or by duration or dose of probiotic. No adverse events associated were found in the 22 controlled trials relating to the use of probiotics.CONCLUSION: This meta-analysis found that probiotics significantly prevented pediatric antibiotic associated diarrhea and pediatric CDI, but the efficacy varies significantly by the strain of the probiotic.
文摘目的:基于网状Meta分析,评价不同中药联合益生菌治疗抗生素相关性腹泻(AAD)的疗效及安全性,为临床安全用药方案提供循证医学依据。方法:在万方数据库、维普数据库、中国知网、中华医学期刊数据库、PubMed、Web of Science等数据库中检索中药联合益生菌治疗AAD的随机对照试验(观察组干预措施为中药联合益生菌,对照组干预措施为单纯使用益生菌),检索时间截至2023年1月。采用贝叶斯网状Meta分析方法,对不同中药联合益生菌治疗AAD的安全性和有效性进行评价。结果:筛选出21篇随机对照试验文献,涉及患者2 093例;使用的中药包括健脾补肾固摄汤、人参败毒散或健脾止泻汤、四逆汤联合四神汤、参术止泻汤、乌梅丸、巴特日-7味丸、胃肠安丸、参苓白术颗粒(参苓白术散)、小儿腹泻散、参苓白术散+补肺汤、醒脾养儿颗粒、儿泻停颗粒、黄芪建中汤、马齿苋煎煮液、固本益肠片共15种。以总有效率为基础指标进行贝叶斯网状Meta分析,结果显示,人参败毒散或健脾止泻汤的效果最佳(OR=12,95%CI=3.1~78.0),且差异有统计学意义(P<0.05)。结论:文献研究前后患者的身体指标未见异常,15种中药联合益生菌治疗AAD的研究方案未对患者造成伤害;同时在鼠类的AAD模型复现上也得到了相应的证实,可以认为本次网状Meta分析的结果是安全、可靠的。本研究中的中药联合益生菌治疗AAD的疗效均优于单纯使用益生菌,能有效缩短病程,为临床用药提供了循证医学证据,但仍需要更多的研究支持和验证。
