| Author, year | Definition of diarrhea | Method for detecting C. difficile | Sample size | Probiotic dosage,CFUs × 109* | Treatment duration | Length of follow-up | Risk of bias† | Industry funded‡ |
|---|---|---|---|---|---|---|---|---|
| Ouwehand et al.,24 2014 | ≥ 3 stools Bristol scale 7 | GDH and toxin A EIA; toxin B by cell culture | Pro-2 168 Pro-1 168 Pla 167 | LA, LPl, B (capsule; L pro-1 4.7, pro-2 17) | Duration of antibiotic treatment + 7 d | 4 wk (post antibiotic treatment) | A | Yes |
| Allen et al.,10 2013 | ≥ 3 stools Bristol scale 5-7, or looser than normal by patient report, in 24 h | In-house tissue culture assay + EIA for toxins or ELFA for toxins or GDH and toxin A EIA | Pro 1493 Pla 1488 | LA, B (capsule; all 60) | 21 d | 8 wk total for AAD/ 12 wk for CDAD | A | No |
| Selinger et al.,25 2013 | ≥ 3 stools Bristol scale 6-7 | ELFA for toxins or GDH and toxin A EIA | Pro 112 Pla 117 | LA, LPl, LPa, LD, B, ST (powder; all 450) | Duration of antibiotic treatment + 7 d | 4 wk (post pro/pla treatment) | B | Yes |
| Gao et al.,20 2010 | ≥ 3 liquid stools in 24 h | Triage panel (not specified) and toxin B by cell culture | Pro-2 86 Pro-1:85 Pla 84 | LA, LC (capsule; pro-1 L 50, pro-2 L 100) | Duration of antibiotic treatment + 5 d | 21 d | A | Yes |
| Sampalis et al.,26 2010 | ≥ 1 episodes unformed or liquid stool in 24 h | Toxin A and B (not specified) | Pro 216 Pla 221 | LA, LC (milk; L 50) | Duration of antibiotic treatment + 5 d | 21 d | C | Yes |
| Safdar et al.,27 2008§ | Watery or liquid stools for ≥ 2 consecutive days | Toxin (not specified) | Pro 23 Pla 17 | LA (capsule; L 20) | Pro 22.8 (9.4) d, pla 24.5 (4.8) d | NR | B | No |
| Beausoleil et al.,28 2007 | ≥ 3 liquid stools in 24 h | Cytotoxin assay (not specified) | Pro 44 Pla 45 | LA and LC (milk; L 50) | Duration of antibiotic treatment | 21 d | C | Yes |
| Hickson et al.,29 2007 | ≥ 2 liquid stools daily in excess of normal for ≥ 2 d | Toxin (not specified) | Pro 69 Pla 66 | LC, LB, ST (yogourt; L 0.1, 0.01, O 0.1) | Duration of antibiotic treatment + 7 d | 28 d | A | No |
| Plummer et al.,30 2004¶ | NA | Latex agglutination or EIA for toxins | Pro 69 Pla 69 | LA, B (capsule, total 20) | 20 d | NR | C | Yes |
| Heimburger et al.,31 1994 | > 200 g stool in 24 h | Culture and titres | Pro 16 Pla 18 | LA, LB (granules, dosage not given) | ≥ 5 d | 5 d | C | No |
Note: AAD = antibiotic-associated diarrhea, B = Bifidobacterium, CDAD = Clostridium-difficile-associated diarrhea, CFUs = colony-forming units, EIA = enzyme immunoassay, ELFA = enzyme-linked fluorescent assay, GDH = glutamate dehydrogenase, L = Lactobacillus spp., LA = L. acidophilus, LB = L. bulgaricus, LC = L. casei, LD = L. delbrueckii subsp. bulgaricus, LPa = L. paracasei, LPl = L. plantarum, NA = not available, NR = not reported, Pla = placebo, Pro = probiotics, ST = Streptococcus thermophilus.
*Dosage is given in colony-forming units unless specified otherwise. Where 2 figures are given, the first represents the total dosage of Lactobacillus species (L), and the second the dosage of other species (O).
†A = no major sources of bias, B = 1 possible source of bias, C = ≥ 2 possible sources of bias.
‡Included direct study sponsorship. We did not consider supply of investigational material without conditions or support for activities not associated with the study as support from the manufacturer.
§Treatment duration is given as mean and standard deviation. Although follow-up was mentioned as part of the study design, the precise duration was not reported.
¶Follow-up was post discharge, but no details were given as to treatment duration post intervention or post discharge.