Saturday, June 22, 2024

Probiotics as Adjuvants in the Treatment of Infectious Diseases: A Meta-Analysis Review

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The growing interest in probiotics has led to a surge in research exploring their potential health benefits. This meta-analysis delves into the effectiveness of probiotics, both single and multiple regimens, as supplementary treatments for various infectious diseases. It meticulously evaluates their impact on conditions such as Helicobacter pylori infections, diarrheal infections, urinary tract infections (UTIs), upper respiratory tract infections (URTIs), and HIV infections.

A comprehensive search across databases including PubMed, Scopus, Embase, and Cochrane identified 6,950 randomized controlled trials. After removing duplicates and filtering titles and abstracts, 32 studies met the inclusion criteria. These comprised 22 studies on H. pylori, 2 on diarrheal infections, 6 on UTIs, and 2 on HIV infections, with no eligible studies for URTIs. The Cochrane Risk of Bias Tool and GRADE were employed to assess bias and evidence certainty, respectively.

Probiotics and H. pylori Eradication

The meta-analysis revealed that probiotics, when used in addition to primary therapy, significantly improved H. pylori eradication rates compared to controls (RR: 1.09; 95% CI: 1.04 – 1.13, p=0.001). Subgroup analysis indicated that standard triple therapy was marginally more effective than quadruple therapy (RR: 1.14 vs. 1.01). Interestingly, single strain probiotics exhibited efficacy comparable to multiple strain regimens, both achieving an RR of 1.09.

Impact on UTIs and Other Infections

For UTIs, probiotics contributed to achieving a cure range of the Nugent score (RR 1.38; 95% CI: 1.01 – 1.89, p=0.04). However, meta-analysis for infectious diarrheal and HIV infections was not feasible due to the limited number of studies and varying methodologies. Despite these limitations, individual studies suggested a reduction in diarrheal incidence and higher rates of complete remission with probiotic regimens.

Concrete Inferences

The meta-analysis provides several actionable insights for healthcare practitioners and researchers:

  • Probiotics enhance the effectiveness of standard triple therapy for H. pylori eradication.
  • Single strain probiotics are as effective as multiple strain regimens in treating H. pylori.
  • Probiotics can improve UTI outcomes as an adjunct to primary treatment.
  • Further research is needed to confirm the benefits of probiotics in diarrheal and HIV infections due to limited and varied existing studies.

This review highlights the promising role of probiotics as adjunctive therapies in treating certain infectious diseases, particularly H. pylori and UTIs. While single and multiple strain probiotics show similar efficacy, their role in treating diarrheal and HIV infections remains inconclusive, necessitating more targeted research.

Original Article: BMC Infect Dis. 2024 May 21;24(1):505. doi: 10.1186/s12879-024-09259-3.

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