To the Editor: The systematic review and meta-analysis by Dr Hempel and colleagues reported the efficacy of probiotics for the prevention and treatment of antibiotic-associated diarrhea (AAD).1 We wish to comment on potential limitations of the analysis.
First, the inclusion criteria seem too broad. The review included any study in which probiotics were administered to patients receiving antibiotics. The review was part of a project on the safety of probiotic use, and some studies had debatable relevance to AAD. In one trial, for instance, probiotics were not administered until day 14 of antibiotic therapy.2
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