PROSPERO International prospective register of systematic reviews
Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis
Susanne Hempel, Paul Shekelle, Sydne Newberry, Ruelaz Alicia, Wang Zhen
Citation
Susanne Hempel, Paul Shekelle, Sydne Newberry, Ruelaz Alicia, Wang Zhen. Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis.
PROSPERO
2011:CRD42011001296
Available from http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42011001296
Review question(s)
To evaluate the evidence for the use of probiotics in the treatment and prevention of antibiotic-associated diarrhea.
Searches
We searched the electronic databases DARE, Cochrane Database of Systematic Reviews, CENTRAL, PubMed, EMBASE, CINAHL, AMED, MANTIS, TOXLINE, ToxFILE, NTIS, and AGRICOLA. References of key articles were screened and the International Journal of Probiotics and Prebiotics was handsearched. Current search dates are inception to August 2010, no language restrictions apply.
Types of study to be included
Parallel RCTs.
Condition or domain being studied
Antibiotic-associated diarrhea.
Participants/ population
Participants of all ages treated with antibiotics regardless of the indication and the patients’ underlying symptoms.
Intervention(s), exposure(s)
Interventions using the genera Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and/or Bacillus alone or in combination, using live (active or lyophilized) microorganism, in probiotic or synbiotic preparations, are eligible.
Comparator(s)/ control
Concurrent control groups of no probiotic treatment, placebo or a different probiotic or a different dose are eligible.
Outcome(s)
Primary outcomes
Diarrhea.
We will use the primary study’s definition of diarrhea ranging from uncomplicated diarrhea to severe diarrhea with complications such as electrolyte imbalance. Outcomes such as watery stool, stool consistency, self reported and physician-defined diarrhea are eligible. Short- and long-term effects will be extracted.
Secondary outcomes
Side effects of probiotic treatment.
Data extraction, (selection and coding)
Two independent reviewers will inclusion screen and assess the included studies, discrepancies will be resolved by discussion in the review team.
Risk of bias (quality) assessment
The Cochrane Risk of Bias tool will be applied. Effects of quality will be assessed in sensitivity analyses.
Strategy for data synthesis
Details of all studies meeting the inclusion criteria will be tabulated in an evidence table. In addition, we will combine trials, where clinically appropriate, in a random effects meta-analysis calculating the relative risk (RR) and the 95% confidence interval (CI) in trials reporting categorical outcomes and effect sizes and 95% CIs in trials with continuous outcomes. Where more than one active treatment group is investigated we will use the maximum probiotics dose, measured as potency and length of time, as the main treatment group. To assess heterogeneity, we will compute the I-squared statistic.
Analysis of subgroups or subsets
We will explore differential effects of the different probiotic genera, age groups (children, adults, elderly) where possible, and the clinical condition and setting.
Dissemination plans
Journal article
Contact details for further information
Susanne Hempel
RAND Corporation
1776 Main Street
Santa Monica, CA 90407
USA
susanne_hempel@rand.org
Organisational affiliation of the review
RAND Corporation
RAND.org
Review team
Dr Susanne Hempel, Rand Professor Paul Shekelle, RAND, VA, UCLA Dr Sydne Newberry, RAND Dr Ruelaz Alicia, RAND Mr Wang Zhen, Pardee RAND Graduate School
Probiotics for the prevention and treatment of antibiotic-associated diarrhea: a systematic review and meta-analysis.
Hempel S, Newberry SJ, Maher AR, Wang Z, Miles JN, Shanman R, Johnsen B, Shekelle PG.
JAMA. 2012 May 9;307(18):1959-69. Review.
PMID: 22570464
Stage of review at time of this submission
Started
Completed
Preliminary searches
No
Piloting of the study selection process
Formal screening of search results against eligibility criteria
Data extraction
Risk of bias (quality) assessment
Data analysis
Prospective meta-analysis
PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites.
