Probiotics in Antibiotic-Associated Diarrhea: Lynne McFarland PhD Advises

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When antibiotics cause infectious diarrhea (AAD)—commonly from Clostridium difficile (CDI)– the offending agent is switched. Data on effective medications as well as on probiotic therapies is growing but most studies deal with adults.

Children are not little adults.

A recent  literature review encompassing nearly 4 decades revealed disparities:


  • Children are affected faster, but have a short run of symptoms and fewer complications.
  • Children acquire infections through community whereas adults are more likely to pick it up in healthcare facilities.


  • Pediatric CDI responds better to metronidazole; few relapse
  • Adult CDI responds better to vancomycin


  • Infection control programs
  • Antibiotic management
  • Probiotics

It makes sense that probiotics should be involved. AAD follows when healthy microbes are zapped alongside pathogens: friendly fire in need of reinforcements. Ergo, probiotics should be given, with consideration to strain, timing and now it appears, a person’s age group.

Clinical epidemiologist Lynne  McFarland at University of Washington shared striking results from a recent meta-analysis:

The pool

  • 26 random controlled trials (RCTs) for pediatric AAD
  • 44 RCTs for adult AAD

Results of analysis

  • 17 different types of probiotics tested in children: three were effective, 14 lacked confirmatory RCTs.
  • 23 different types of probiotics tested in adults: 6 were effective, 4 types were not effective, and 13 lacked confirmatory RCTs.

For much more detail on probiotic strains and efficacy, read Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections which appeared in World Journal of Gastroenterology in March of 2016.

Also read McFarland’s fascinating and thorough From yaks to yogurt: the history, development, and current use of probiotics which appeared in Clinical Infectious Diseases in March 2015.

In the video above, recorded at the 2016 Harvard Probiotics Symposium, McFarland gives practical advice on taking probiotics for prevention and treatment of AAD. Don’t miss it.