Probiotics May Reduce Antibiotic Prescriptions for Children

We often hear probiotics criticized that they “don’t do anything for healthy people.” This admonition ignores data, which I’ve disputed (see past post). And a new, open-access meta-analysis suggests another possible benefit of probiotics for healthy people: probiotic administration is associated with reduced antibiotic prescriptions in healthy children.

The analysis included results from 17 studies, which were all conducted in infants or children. A measure of antibiotic use was a secondary aim for most of these studies; the primary aim was preventing acute respiratory tract infections, acute lower digestive tract infections or acute otitis media. The probiotics were single or multiple strain formulation of Lactobacillus and/or Bifidobacterium strains delivered in supplements, fermented milks or yogurt.

Results show that infants or children who received probiotics had a 29% reduced relative risk (compared to placebo) of being prescribed an antibiotic. The results were even stronger when restricted to the studies evaluated as having a low risk of bias. For those five studies, the relative risk reduction was 53%.

In an era of heightened interest in antibiotic stewardship, that is quite an interesting finding. If extrapolated population wide, it could mean millions of fewer antibiotic prescriptions.

The authors (of which I was one) speculated about what might have driven this association. Fewer antibiotic prescriptions may occur because children on probiotics get fewer acute respiratory infections (see here) or their infections have a shorter duration (see here). Fewer illnesses or shorter illnesses, fewer visits to doctors, fewer antibiotic prescriptions. Since probiotics may reduce the duration of an acute, self-limited illness, when caregivers want to “do something” for a sick child, a probiotic would be a better intervention than an unnecessary antibiotic prescription. The CDC estimates that in the U.S., 34% of antibiotic prescriptions written for Americans 0-19 years of age for acute respiratory infections are unnecessary.

The study was undertaken after a discussion at an ISAPP meeting on the strength of evidence that probiotics can reduce the incidence and duration of common infections.

Also see:

ISAPP-Initiated Systematic Review and Meta-Analysis Shows the Association of Probiotic Consumption with Reduced Antibiotic Prescriptions

ISAPP press release

Georgetown University press release