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.