Antibiotic-associated Diarrhea
In most published RCTs, probiotics were given in parallel to the started antibiotics (most often for treatment of acute respiratory infections). A meta-analysis of 6 RCT results demonstrated a reduced risk for developing antibiotic-associated diarrhea from 28.5% to 11.9% (RR: 0.44 [95% CI: 0.25–0.77]; P = 0.006; number needed to treat = 7). A recently published Cochrane systematic review also demonstrated that high-dose prebiotics had a protective effect toward preventing antibiotic-associated diarrhea in children in comparison with placebo (prevalence 8% versus 22%; RR: 0.40 [95% CI: 0.29–0.55]; number needed to treat = 7). As many studies investigated synbiotics, data are sparse for prebiotic effects only. A recently conducted study could not show any differences between the intervention group (oligofructose and inulin) and the control group. Unlike in adults, therapeutic effects of probiotics in antibiotic-associated diarrhea or Clostridium difficile-associated diarrhea in children have not been investigated in RCTs.