Abstract

Antibiotic-associated diarrhea (AAD) is a common side effect of antibiotic therapy in children and is mostly brought on by disruption of the gut microbiota. Probiotics have been recommended as a prophylactic intervention, although the safety and effectiveness of these treatments in young populations are still up for debate. This systematic review and meta-analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards and registered under PROSPERO (CRD420251207959) to evaluate the safety and effectiveness of probiotics in reducing antibiotic-associated diarrhea in children. The electronic databases were searched. Probiotics and antibiotics were used in randomized controlled studies to prevent AAD in children aged 0 to 18 years. The meta-analysis produced pooled odds ratios (ORs) with 95% confidence intervals under a random-effects model using Review Manager (RevMan) version 5.3. Ten randomized controlled studies were included in the study. Probiotic use showed a non-significant tendency toward reducing the incidence of AAD when compared to the control group (OR = 0.58, 95% CI: 0.33–1.02; p = 0.06). The significant heterogeneity (I2 = 71%) decreased to 43% after one study was removed from the sensitivity analysis. The absence of a significant difference in adverse effects between the probiotic and control groups (OR = 0.91; 95% CI: 0.40–2.10; p = 0.83) suggested a satisfactory safety profile. Probiotics had a non-significant trend in reducing AAD in children and were found to be safe, with no increase in side effects. The observed variation highlighted the need for more meticulously designed large-scale randomized trials using specific probiotic strains and defined definitions of AAD to more precisely evaluate their preventative effects.

Key words: Antibiotic-associated diarrhea, probiotics, children, pediatric, systematic review, meta-analysis