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.
Summary
Korean summary
활생제가 여행자설사를 예방하는 효과가 있는가에 대한 기존 메타분석결과들과 지침간의 괴리가 확인되어서 갱신용 메타분석을 수행하였다. 총 11편의 무작위배정, 위약대조비교 임상시험결과에 대한 메타분석결과 통계적으로 유의한 효과가 있는 것으로 산출되었다 (summary relative risk =0.85; 95% confidence interval: 0.77-0.91).
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