Keywords
Diarrhea
Antibiotics
Randomized Controlled Trials
Systematic Review
Categories
Abstract
Background: Antibiotic-associated diarrhea (AAD) is a common adverse effect that negatively impacts quality of life, treatment adherence, and healthcare costs. Probiotics have been proposed as a preventive or therapeutic strategy; however, the available evidence shows substantial clinical heterogeneity and methodological limitations, which hinder its interpretation and application within evidence-based clinical practice. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. Only randomized controlled trials evaluating the use of probiotics for the prevention or management of AAD were included. The search was reproduced on January 10, 2026. Primary clinical outcomes were extracted, and risk of bias (RoB 2), methodological quality (JBI), and reporting quality (CONSORT 2025) were assessed. Results were synthesized using a narrative approach. Results: Nine randomized controlled trials involving a total of 2,052 participants were included. Seven studies reported a significant reduction in the incidence of AAD associated with probiotic use, whereas two showed null or modest effects. Most studies presented some concerns regarding risk of bias, mainly related to blinding and incomplete reporting of methodological details. Overall methodological quality was moderate to high, although adherence to CONSORT standards was limited, particularly in domains related to open science and transparency. Conclusion: Probiotics may reduce the incidence of AAD in selected populations; however, the certainty of the evidence remains variable. Integrating meta-scientific approaches with evidence-based medicine is essential to appropriately interpret these findings and to guide future, more rigorous and transparent research.
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Copyright (c) 2026 Isabella Vejarano Vega, Carlos Enrique Parra Guayazan, Christian Camilo Romero Amaya, John Fredy Ortiz Caviedes, Yulieth Paola Zemanate Muñoz, Andrea Paola Baena Manotas, Andrea Carolina Mora Ochoa, Yelson Alejandro Picón Jaimes