Probiotics can prevent and treat diarrhea. For a relatively low cost and provided there is a highly potent cell count, healthy bacteria could save an individual many miserable hours of diarrhea, prevent dehydration and hospitalization, and prevent school/work absenteeism.

SCIENTIFIC BRIEF

Research Supports Use of Probiotics
for Preventing and Treating Diarrhea

To be effective for managing diarrhea, probiotics should:

  1. Be non-pathogenic
  2. Act against pathogens by mechanisms different from antibiotics
  3. Have a rapid onset of action
  4. Survive in gastric acid and bile
  5. Enhance immune function

Several probiotics do all of these things!

Particular strains of lactobacillus, Saccharomyces boulardii, and combined lactobacillus/bifidobacteria products have been extensively studied for treatment and prevention of diarrhea, including acute diarrheal episodes caused by viruses, as well as diarrhea induced by taking antibiotics.

Diarrhea is a common side effect of antibiotic treatment, especially among children.  As many as 11-40% of children develop diarrhea while taking antibiotics.  While no infectious microorganism is identified most of the time, a bacterium called Clostridium difficile is often the culprit underlying severe diarrheal episodes.  To date, eight 1,2,3,4,5,6,7,8, systematic reviews and meta-analyses have found probiotics effective at treating or preventing diarrhea.

Preventing Diarrhea
The largest meta-analysis to evaluate probiotics for diarrhea management looked at the ability of healthy microorganisms to prevent diarrhea by reviewing data from 34 different clinical trials involving 4844 patients.  Overall, probiotics reduced the likelihood of developing antibiotic-associated diarrhea by 52% and reduced the incidence of other types of acute diarrhea by 34%.  The benefits of probiotics were most pronounced among children.  In 12 pediatric studies included in this analysis, probiotics reduced the likelihood of acute diarrhea in children by 57% (p<0.001). A 26% reduction of acute diarrhea was observed for adults. 6 

Similar benefits were also obtained by others who found that probiotics reduced the risk of antibiotic-associated diarrhea from 28.5% with placebo down to 11.9%.  In fact, it became apparent from an analysis by Szajewska and colleagues that for every 7 patients that would normally develop diarrhea while taking antibiotics, one fewer person would get antibiotic-associated diarrhea if also taking a probiotic simultaneously. 7

McFarland reviewed 25 studies that utilized probiotics to prevent antibiotic-associated diarrhea including confirmed cases of diarrhea caused by Clostridium difficile.  With probiotics, the relative risk for antibiotic-associated diarrhea was 0.43 (95% CI, 0.31-0.58; p<0.001) and for preventing Clostridium difficile diarrhea was 0.59 (95% CI, 0.41-0.85; p=0.005).8  Thus, it is clear that probiotics can prevent antibiotic-associated diarrhea.

Treating Acute Diarrhea
Similarly, three meta-analyses 3,4,5, evaluated a total of 20 primary probiotic studies and found that probiotics, especially those products that contain lactobacillus, are effective treatments for acute diarrhea. According to these analyses, lactobacillus reduces the duration of diarrhea 0.6-0.7 days and reduces stool frequency.

Conclusion:
Probiotics can prevent and treat diarrhea. Of course, in addition to clinical benefits of using probiotics, there are practical implications, too.  For a relatively low cost and provided there is a highly potent cell count, healthy bacteria could save an individual 17 hours of diarrhea, prevent dehydration and hospitalization, and prevent school/work absenteeism.

 

  1. D’Souza AL, Rajkumar C, Cooke J, Bulpitt CJ. Probiotics in prevention of antibiotic associated diarrhea: meta-analysis. BMJ. 2002;324:1361-1366
  2. Cremonini F, Di Caro S, Nista EC. Bartolozzi F, Capelli G, Gasbarrini G, Gasbarrini A. Meta-analysis: the effect of probiotic administration on  antibiotic-associated diarrhoea. Aliment Pharmacol Thera. 2002;16:1461-1467.
  3. van Niel CW, Feudtner C, Garrison MM, Christakis DA. Lactobacillus therapy for acute infectious diarrhea in children: a meta-analysis. Pediatrics. 2002;109:678-684.
  4. Szajewska H, Mrukowicz JZ. Probiotics in the treatment and prevention of acute infectious diarrhea in infants and children: a systematic review of published randomized double-blind, placebo-controlled trials. J Pediatr Gastroenterol Nutr. 2001;33 Suppl 2:S17-25.
  5. Huang JS, Bousvaros A, Lee JW, Diaz A, Davidson EJ. Efficacy of probiotic use in acute diarrhea in children: a meta-analysis. Dig Dis Sci. 2002;47:2625-2634.
  6. Sazawal S, Hiremath G, Dhingra U, Malik P, Deb S, Black RE. Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomized, placebo-controlled trials. Lancet Infect Dis. 2006;6:374-382.
  7. Szajewska H, Ruszczynski M, Radzikowski A. Probiotics in the prevention of antibiotic-associated diarrhea in children: A meta-analysis of randomized controlled trials. J Pediatr. 2006;149:367-372.
  8. McFarland LV. Meta-analysis of probiotics for the prevention of antibiotic associated diarrhea and the treatment of Clostridium difficile disease. Am J Gastroenterol. 2006;101:812-822.