Role of Multispecies Probiotics in Antibiotic-Associated Diarrhea in Children

The efficacy of multispecies probiotic formulations in preventing antibiotic-associated diarrhea (AAD) remains unclear. The present study assessed the effect of a multispecies probiotic on the risk of AAD in children.

This randomized trial followed up with the Patients throughout the intervention period. It recruited children aged three months to 18 years within 24 hours following the initiation of broad-spectrum systemic antibiotics. In total, this study approached 646 eligible patients and included 350.

The study administered a multispecies probiotic consisting of Bifidobacterium bifidum W23, Bifidobacterium lactis W51, Lactobacillus acidophilus W37, L acidophilus W55, Lacticaseibacillus paracasei W20, Lactiplantibacillus plantarum W62, Lacticaseibacillus rhamnosus W71, and Ligilactobacillus salivarius W24, for a total dose of 10 billion colony-forming units/day, for the duration of antibiotic treatment and seven days after.

It looked for AAD, defined as three or more loose or watery stools/day in 24 hours, caused either by Clostridioides difficile or otherwise unexplained etiology, after testing for common diarrheal pathogens. The secondary outcomes included diarrhea regardless of etiology, duration, and predefined complications.

The study observed-

• Randomization of 350 children (192 boys and 158 girls; mean [range] age, 50 [3-212] months) and inclusion of 313 in the intention-to-treat analysis.
• No effect on the risk of AAD with probiotics than placebo; however, children in the probiotic group had a lower risk of diarrhea regardless of the etiology.
• No differences between the groups for most of the secondary outcomes, including adverse events.

This study shows that a multispecies probiotic does not reduce the risk of AAD in children when analyzed according to the most stringent definition. However, it reduces the overall risk of diarrhea during and for seven days after antibiotic treatment. 

Łukasik J, et al. Multispecies Probiotic in AAD Study Group. Multispecies Probiotic for the Prevention of Antibiotic-Associated Diarrhea in Children: A Randomized Clinical Trial. JAMA Pediatr. 2022;176(9):860–866. doi:10.1001/jamapediatrics.2022.1973