Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2018:40:e2018043.
doi: 10.4178/epih.e2018043. Epub 2018 Aug 29.

Prophylactic efficacy of probiotics on travelers' diarrhea: an adaptive meta-analysis of randomized controlled trials

Jong-Myon Bae  1
Affiliations
Meta-Analysis

Prophylactic efficacy of probiotics on travelers' diarrhea: an adaptive meta-analysis of randomized controlled trials

Jong-Myon Bae. Epidemiol Health. 2018.

Abstract

Objectives: The 2017 guideline for the prevention of travelers' diarrhea (TD) by the International Society of Travel Medicine suggested that 'there is insufficient evidence to recommend the use of commercially available prebiotics or probiotics to prevent or treat TD.' However, a meta-analysis published in 2007 reported significant efficacy of probiotics in the prevention of TD (summary relative risk [sRR], 0.85, 95% confidence interval [CI], 0.79 to 0.91). This study aimed to synthesize the efficacy of probiotics on TD by updating the meta-analysis of double-blind, placebo-controlled, randomized human trials.

Methods: The search process was conducted by the adaptive meta-analysis method using the 'cited by' and 'similar articles' options provided by PubMed. The inclusion criteria were double-blind, placebo-controlled, randomized human trials with hypotheses of probiotics as intervention and TD as an outcome. The adaptive meta-analysis was conducted using Stata software using the csi, metan, metafunnel, and metabias options.

Results: Eleven articles were selected for the meta-analysis. The sRR was 0.85 (95% CI, 0.79 to 0.91) and showed statistical significance. There was no heterogeneity (I-squared=28.4%) and no publication bias.

Conclusions: Probiotics showed statistically significant efficacy in the prevention of TD.

Keywords: Diarrhea; Meta-analysis; Probiotics; Randomized controlled trials.

PubMed Disclaimer

Conflict of interest statement

The author has no conflicts of interest to declare for this study.

Figures

Figure 1.
Figure 1.
Flow chart of articles’ selection.
Figure 2.
Figure 2.
Forest plot from 11 selected articles. FA_RN, first author & reference number; ES, effect size.
Figure 3.
Figure 3.
Funnel plot (Begg’s test: p=0.94; Egger’s test: p =0.83). SE, standard error; RR, relative risk.
See this image and copyright information in PMC

References

    1. Riddle MS, Connor BA, Beeching NJ, DuPont HL, Hamer DH, Kozarsky P, et al. Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report. J Travel Med. 2017;24:S57–S74. - PMC - PubMed
    1. Gascón J. Epidemiology, etiology and pathophysiology of traveler’s diarrhea. Digestion. 2006;73 Suppl 1:102–108. - PubMed
    1. Virk A, Mandrekar J, Berbari EF, Boyce TG, Fischer PR, Kasten MJ, et al. A randomized, double blind, placebo-controlled trial of an oral synbiotic (AKSB) for prevention of travelers’ diarrhea. J Travel Med. 2013;20:88–94. - PubMed
    1. Sazawal S, Hiremath G, Dhingra U, Malik P, Deb S, Black RE. Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebo-controlled trials. Lancet Infect Dis. 2006;6:374–382. - PubMed
    1. McFarland LV. Meta-analysis of probiotics for the prevention of traveler’s diarrhea. Travel Med Infect Dis. 2007;5:97–105. - PubMed

Publication types