Probiotics provided to reduce the risk for common acute infections may be associated with reduced antibiotic use in infants and children, according to a study recently published in the European Journal of Public Health.
The threat of antibiotic-resistant pathogens has led many public health organizations worldwide to work toward improving the appropriate use of antibiotics. Avoidance of prescribing antibiotics for viral illnesses and developing management plans that reduce the frequency and duration of symptoms are both means of reducing antibiotic use. Evidence suggests that probiotic supplementation reduces episodes of common infectious diseases in otherwise healthy children and adults with common acute respiratory conditions. By decreasing the incidence and severity of common acute infections, probiotic supplementation may potentially be associated with decreased antibiotic use. However, the relationship between probiotic use and antibiotic use has not be systemically reviewed. This systematic review explored whether antibiotic prescriptions are reduced in the target populations of studies that investigated probiotics to reduce the risk for common acute illnesses.
Investigators searched 13 electronic databases from their inception to January 2017 and 2 reviewers selected studies for inclusion independently and extracted study data. A total of 17 randomized clinical trials were included. All trials were conducted in infants and/or children and the primary outcome was to prevent acute respiratory tract infection, acute lower digestive tract infection, or acute otitis media. The risk for bias in individual studies was assessed using criteria adapted from the Centre for Reviews and Dissemination, and the quality of evidence for each outcome was assessed using the GRADE system. Studies that evaluated similar outcomes were pooled statistically in meta-analyses using a random-effects model.
Included studies used 12 probiotic formulations, all of which were comprised of single or combination Lactobacillus and Bifidobacterium delivered in a range of food or supplement products. Mean duration of probiotic supplementation ranged from 4 days to 9 months. Meta-analysis demonstrated that infants and children who received probiotics to prevent acute illnesses had a 29% lower risk for being prescribed antibiotics relative to those who received a placebo (pooled relative risk .71; 95% CI, .54-.94; P =.02). For patients with a hypothesized 25% risk for being prescribed an antibiotic, the number needed to treat to avoid 1 prescription was 13.8. When restricted to 5 studies with a low risk for bias, the pooled relative risk was .46. Significant statistical heterogeneity was present in effect size estimates, which appeared to be caused by one trial that could partly be considered an outlier. None of the studies reported whether patients took the full prescribed course or what the prescription lengths were and therefore it is unclear whether data reflect prescription length or consumption.
Overall, the study authors concluded that, “Probiotic consumption may be a replacement for antibiotics as patients and clinicians manage self-limited illnesses.”
Disclosure: All authors received compensation for travel and lodging by International Scientific Association for Probiotics and Prebiotics (ISAPP) to attend the 2016 Annual ISAPP Meeting in Turku, Finland, where the manuscript was conceived. SK received an honorarium as partial compensation for time spent conducting this systematic review. DT has received research and travel support from ISAPP. ALS and DM have received support for travel and lodging from ISAPP, to participate in research conferences and meetings sponsored by ISAPP.
King S, Tancredi D, Lenoir-Wijnkoop I, et al. Does probiotic consumption reduce antibiotic utilization for common acute infections? A systematic review and meta-analysis [published online September 14, 2018]. Eur J Public Health. doi:10.1093/eurpub/cky185