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BACKGROUND Antibiotic-associated diarrhea (AAD) is a side-effect frequently associated with the use of broad spectrum antibiotics. Although a number of clinical studies show that co-administration of specific probiotics reduces the risk for AAD, there is still unclarity among healthcare professionals on the recommendation of probiotic products. OBJECTIVE This paper aims to provide a practical guide to inform healthcare professionals, patients and consumers about the exact product characteristics of available probiotics with a proven efficacy to prevent AAD. DESIGN and METHODS The workflow in this paper includes three consecutive steps: a systematic review of relevant clinical studies for effective probiotics by a meta-analysis, compilation of a list of available probiotic products, and recommendation of probiotic products that match effective formulations. Our systematic review on the efficacy of probiotics for the prevention of AAD included only studies with randomized, double blind placebo-controlled trials, a clear definition of antibiotic associated diarrhea, and a probiotic administration regime for at least the duration of the antibiotic therapy. RESULTS Using our inclusion criteria, we selected 32 out of 128 identified trials and pooled the results of these studies for each specific dairy product and food supplement. The results indicate a total of seven single or multiple-strain formulations favoring the probiotic treatment group, with the strain Lactobacillus rhamnosus GG being the most effective (relative risk ratio of probiotic versus placebo 0.30 with 95% CI 0.16 - 0.5]. We selected products for recommendation from a compiled list of all probiotic dairy products and food supplements available in The Netherlands and categorized them into groups of products showing effects against the incidence of AAD in at least one, two, or three independent clinical studies. We excluded all products which did not unambiguously declare on the label the specific probiotic strain(s) and the number of colony forming units. CONCLUSION Here, we present a practical guide that informs healthcare professionals and patients on the availability of probiotic products with a proven efficacy for the prevention of AAD.

De darmmicrobiota van de mens is essentieel voor de spijsvertering en voor afweer tegen infecties. De goede bacteriën in de darm houden (potentieel) pathogenen onder controle. Wanneer het bacteriële evenwicht verstoord wordt door gebruik van antibiotica, dan kan dat onder andere leiden tot diarree. Probiotica, gedefinieerd als levende bacteriën met een gezondheidbevorderend effect, zijn in staat het bacteriële evenwicht in de darm te stabiliseren en te herstellen wanneer ze in de juiste hoeveelheden worden toegediend. Uit een groot aantal klinische studies is naar voren gekomen dat probiotica het optreden van door antibiotica geïnduceerde diarree met ongeveer de helft kunnen terugdringen. Het best onderzocht zijn Lactobacillus rhamnosus GG en de gist Saccharomyces boulardii. Om de verstoring door antibiotica van het bacteriële evenwicht in de darmen te verminderen – en de daarmee gepaard gaande diarree – zouden huisarts en apotheker de patiënten die antibiotica voorgeschreven krijgen, ook dienen te adviseren over gelijktijdig gebruik van probiotica.