S2943 Efficacy and Safety of Probiotics for Antibiotic-Associated Diarrhea: A Systemic Review and Meta-Analysis

Introduction: Antibiotic-associated diarrhea (AAD) is a common complication in children taking antibiotics often causing discomfort and disrupting treatment. Previous studies showed probiotics helped reduce the incidence of AAD but their effectiveness can vary depending on the strain used, and clinical setting. This study aims to evaluate the preventive effect of probiotics on AAD in children, highlighting these important factors. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials to assess the safety and efficacy of probiotics for preventing AAD in children aged 1 to 18 years. Major medical databases were screened from inception to May 2025. Studies included children who received probiotics alongside antibiotics and reported either diarrhea or any side effects. Two reviewers independently extracted data and assessed the quality of the studies. Risk ratios with 95% confidence intervals were calculated. We also explored how the results varied by probiotic type, treatment setting (hospital or outpatient), and the method of antibiotic administration (oral or intravenous). Results: Twenty-four randomized controlled trials were included with a total of 12,975 children. Overall, probiotics demonstrated a lower risk of AAD (RR: 0.41; 95% CI: 0.36–0.48). Among the strains, Saccharomyces boulardii and Lactobacillus rhamnosus showed the strongest effects, both with very low heterogeneity across studies. Multispecies probiotics were also helpful, though results varied more. Probiotics worked well in both hospitals and outpatient clinics. A lower need for intravenous fluids was observed in children taking probiotics. Importantly, probiotics did not cause major side effects and minor side effects were also less common. Conclusion: Probiotics, especially S. boulardii and L. rhamnosus, are effective and safe for preventing antibiotic-associated diarrhea in children. They reduce the chance of diarrhea and the need for medical support like IV fluids, with few side effects. These findings support the use of probiotics as a preventive measure in pediatric care.