Ask an answerable question (PICO)：
Antibiotic-associated diarrhea (AAD) typically refers to diarrhea that occurs without a clear cause and within one to eight weeks after antibiotic treatment has been initiated or discontinued. According to statistics, the incidence of AAD in hospitalized adults and elderly patients can be as high as 39%, leading to increased hospitalization time, medical costs, and risk of death. Therefore, this study aimed to investigate whether the use of probiotics could prevent the incidence of AAD and provide treatment recommendations for clinical practice.
The Method and Analysis of Literature Review：
We formulated a PICO (Population, Intervention, Comparison, Outcome) question based on the clinical problem, selected relevant keywords and their synonyms, and confirmed MeSH terms. A comprehensive literature search was conducted without language restrictions in four electronic databases (PubMed, Embase, Cochrane Library, and Airiti Library) using Boolean operators. The identified articles were screened based on predefined inclusion and exclusion criteria, resulting in the selection of four systematic reviews and meta-analyses and two randomized controlled trials that met the PICO criteria. After evaluation and discussion, three systematic reviews and meta-analyses with higher levels of evidence and more recent publication years were chosen for the final literature review.
Critical Appraisal：
According to the 2011 Oxford Centre for EBM Levels of Evidence (OCEBM), the three systematic reviews and meta-analyses were assessed as Level Ⅰa evidence. In addition, we used the Critical Appraisal Skill Program (CASP) systematic review checklist developed by the Oxford Centre for Evidence-Based Medicine in 2018 to analyze the validity, importance, and applicability of the literature. Based on the results of this evidence-based study and past related research conclusions, it is believed that continuing to use probiotics containing Lactobacillus within 48 hours after antibiotic use can reduce the incidence of antibiotic-associated diarrhea in adults and elderly by approximately 29-38%.
Results, Conclusions and Recommendations：
After comprehensive evaluation of the evidence-based literature, it is recommended that adult and elderly patients who are hospitalized and receiving antibiotic treatment should use probiotic products containing Lactobacillus within 48 hours of initiating antibiotics and continue their use throughout the course of antibiotic treatment. This approach can reduce the incidence of antibiotic-associated diarrhea by approximately 29-38% in adult and elderly patients. Additionally, probiotics have been found to decrease the incidence of diarrhea and increase the likelihood of successful treatment when used in conjunction with treatment for Helicobacter pylori infection.
The common side effects of probiotics mainly include gastrointestinal discomfort such as bloating, abdominal pain, nausea, and vomiting, and there have been no reports of other significant adverse events. However, further investigation is needed to determine optimal dosage, duration of use, and appropriate strains of probiotics to be used in conjunction with specific antibiotics.
Therefore, it is recommended that clinicians follow the evidence-based literature and select appropriate probiotic products for use under the guidance of a physician or nutritionist to reduce the incidence of antibiotic-associated diarrhea and improve treatment outcomes. Future studies are needed to investigate factors related to probiotic use and to develop more precise clinical recommendations.
