Probiotics for prevention of antibiotic-associated diarrhea
Probiotics for prevention of antibiotic-associated diarrhea
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DOI：
10.1097/mcg.0b013e3181618ab7
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发表时间：
2008-07-01
影响因子：
2.9
通讯作者：
Gorbach, Sherwood L.
中科院分区：
文献类型：
--
作者：
Doron, Shira Idit;Hibberd, Patricia L.;Gorbach, Sherwood L.
大约 25% 接受抗生素治疗的患者会出现抗生素相关性腹泻 (AAD)。住院的 AAD 患者发生院内感染的风险增加，死亡率也更高。益生菌是活微生物，用于通过改变肠道微生物群来恢复肠道健康。已经研究了几种预防 AAD 的方法。已经对益生菌预防 AAD 的试验进行了五项荟萃分析。结果显示，当益生菌与抗生素联合使用时，AAD 的风险总体降低。 McFarland 进行了迄今为止最大规模的荟萃分析，分析了 25 项益生菌预防 AAD 的随机对照试验，其中包括 2810 名受试者。超过一半的试验证明了益生菌的功效。尤其是，GG 乳杆菌、布拉氏酵母菌和益生菌混合物非常有效。 Cochrane 系统评价数据库发表了一篇关于使用益生菌预防儿科 AAD 的文献综述，其中包括对 1986 名儿童进行测试的 10 项随机试验。每个方案的汇总分析（而非意向治疗分析）表明，益生菌可有效预防 AAD，预防 I 例腹泻所需的治疗数量为 10 颗。GG 乳杆菌、凝结芽孢杆菌和布拉氏链球菌似乎最有效。益生菌通常是安全的，但对于免疫系统或肠粘膜完整性受损以及存在中心静脉导管的患者应谨慎使用。
Anti biotic-associated diarrhea (AAD) occurs in approximately 25% of patients receiving antibiotics. Hospitalized patients with AAD are at increased risk for nosocomial infections and have a higher mortality. Probiotics are living microorganisms used to restore gut health by changing the intestinal microbiota. Several have been studied for the prevention of AAD. Five meta-analyses of trials of probiotics for the prevention of AAD have been performed. The results showed an overall reduction in the risk of AAD when probiotics were coadministered with antibiotics. McFarland conducted the largest meta-analysis to date analyzing 25 randomized controlled trials of probiotics for the prevention of AAD including 2810 subjects. More than half of the trials demonstrated efficacy of the probiotic. In particular, Lactobacillus GG, Saccharomyces boulardii, and the probiotic mixtures were effective. The Cochrane Database of Systematic Reviews published a review of the literature on the use of probiotics for the prevention of pediatric AAD, including 10 randomized trials testing 1986 children. The per protocol pooled analysis, but not the intent-to-treat analysis, showed that probiotics are effective for preventing AAD with the number needed to treat to prevent I case of diarrhea being 10. Lactobacillus GG, Bacillus coagulans, and S. boulardii appeared to be most effective. Probiotics are generally safe, however, they should be used with caution in patients who have compromise of either the immune system or the integrity of the intestinal mucosa, and in the presence of a central venous catheter.