Probiotics have become more widely used for a number of reasons, including lowering the risk and incidence of some acute infections. Although they’re commonly prescribed after a course of antibiotics, a recent study demonstrated that probiotics may actually help to reduce the use of antibiotics in infants and children.
 
A systematic review and meta-analysis published Sep. 14 in the European Journal of Public Health sought to understand if probiotic consumption reduced antibiotic utilization for common acute infections.
 
Overall reduction of antibiotic use is a widely adopted public health goal. Given evidence that consuming probiotics reduce the incidence, duration, and/or severity of certain types of common acute infections, researchers hypothesized that probiotics are associated with reduced antibiotic use. This systematic review of randomized controlled trials (RCTs) assessed the impact of probiotic supplementation (any strain, dose, or duration), compared to placebo, on antibiotic utilization for common, acute infections in otherwise healthy people of all ages. 
 
Researchers searched 13 electronic databases including Medline, Embase and CENTRAL from inception to Jan. 17, 2017. Backward and forward citation searches were also conducted. Two reviewers independently selected studies for inclusion and extracted study data. They assessed risk of bias for individual studies using criteria adapted from the Centre for Reviews and Dissemination, and the quality of evidence for each outcome was assessed using the GRADE system. Studies that evaluated similar outcomes were pooled statistically in meta-analyses using a random-effects model. 
 
Researchers screened 1,533 citations, and of these, 17 RCTs met predefined inclusion criteria. All 17 were conducted in infants and/or children with a primary aim of preventing acute respiratory tract infections, acute lower digestive tract infections, or acute otitis media. Included studies used 13 probiotic formulations, all comprising single or combination Lactobacillus and Bifidobacterium delivered in a range of food or supplement products. Mean duration of probiotic supplementation ranged from 4 days to 9 months. Trial quality was variable.
 
Meta-analysis demonstrated that infants and children who received probiotics to prevent acute illnesses had a lower risk of being prescribed antibiotics, relative to those who received placebo (Pooled Relative Risk = 0.71, 95% CI: 0.54 – _0.94). When restricted to five studies with a low risk of bias, the pooled relative risk was 0.46 (95% CI: 0.23-0.97). Significant statistical heterogeneity was present in effect size estimates, which appeared to be due to one trial which could partly be considered as an outlier. 
 
Researchers concluded that probiotics provided to reduce the risk for common acute infections may be associated with reduced antibiotic use in infants and children. Additional well-designed studies are needed to substantiate these findings in children and explore similar findings in other population groups.