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Multi-strain probiotics

Cochrane: multi-strain probiotics reduce antibiotic-associated diarrhoea and C.

Why

Cochrane: multi-strain probiotics reduce antibiotic-associated diarrhoea and C. diff risk. Strain-specific evidence for IBS (Bifidobacterium infantis 35624).

How it works

Diverse strain combinations colonise the gut transiently and produce strain-specific immunomodulatory and barrier-supportive effects. Cochrane evidence is strongest for antibiotic-associated diarrhoea prevention.

Expected onset · C. diff-prevention effect requires use throughout the antibiotic course

How to take

Dosage

For C. difficile prevention during antibiotics: ≥10 billion CFU/day, started within 2 days of antibiotic initiation, continued through and 5–7 days beyond the antibiotic course.

Timing

Separate from antibiotic dose by 2 hours; with or just after a meal

Safety

Generally well-tolerated. Avoid in severely immunocompromised patients, central venous catheters, or critical illness.

Evidence

At a glance

Goldenberg 2017 Cochrane review (39 trials, n=9,955 adults and children on antibiotics): probiotics started within 2 days of antibiotic initiation reduced the incidence of C. difficile-associated diarrhoea from 4.0% to 1.5% (RR 0.40, 95% CI 0.30–0.52), NNT around 42, but the relative risk reduction is large in high-risk settings. Moderate-certainty evidence.

Where to get it

Shop Multi-strain probiotics on Amazon

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