P1885 - Efficacy and Safety of Probiotics for Antibiotic-Associated Diarrhea: A Systemic Review and Meta-Analysis

Ahmad Zulaid, MD¹, Noor Ul Sabah, MBBS², Adnan Rafiq, MBBS³, Usman Saeed, MD⁴, Muhammad Zohaib Qasim, MD⁵, Hafiz Noor Ullah Fayyaz, MD², Nabiha Mustafa, ⁶, Jumana Khan, MBBS⁷, Maryam Jamil, MBBS⁸
1Quaid-e-Azam Medical College, Bahawalpur, Pakistan, Multan, Punjab, Pakistan; 2Quaid-e-Azam Medical College, Bahawalpur, Punjab, Pakistan; 3Hunan Normal University School of Medicine, Multan, Punjab, Pakistan; 4Jinnah Hospital Lahore, Lahore, Punjab, Pakistan; 5Department of Medicine, Quaid-e-Azam Medical College, Bahwalpur, Punjab, Pakistan; 6Bakhtawar Amin Medical and Dental College, Multan, Punjab, Pakistan; 7Multan medical and dental college., Multan, Punjab, Pakistan; 8Bakhtawar Amin Medical and Dental College,Multan,Pakistan, Multan, Punjab, Pakistan

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 IV).

Results: 24 RCTs 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.

Discussion: 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.

Disclosures:
Ahmad Zulaid indicated no relevant financial relationships.
Noor Ul Sabah indicated no relevant financial relationships.
Adnan Rafiq indicated no relevant financial relationships.
Usman Saeed indicated no relevant financial relationships.
Muhammad Zohaib Qasim indicated no relevant financial relationships.
Hafiz Noor Ullah Fayyaz indicated no relevant financial relationships.
Nabiha Mustafa indicated no relevant financial relationships.
Jumana Khan indicated no relevant financial relationships.
Maryam Jamil indicated no relevant financial relationships.

Ahmad Zulaid, MD¹, Noor Ul Sabah, MBBS², Adnan Rafiq, MBBS³, Usman Saeed, MD⁴, Muhammad Zohaib Qasim, MD⁵, Hafiz Noor Ullah Fayyaz, MD², Nabiha Mustafa, ⁶, Jumana Khan, MBBS⁷, Maryam Jamil, MBBS⁸. P1885 - Efficacy and Safety of Probiotics for Antibiotic-Associated Diarrhea: A Systemic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.