Deciphering meta-analytic results: a mini-review of probiotics for the prevention of paediatric antibiotic-associated diarrhoea and Clostridium difficile infections

2015 ◽  
Vol 6 (2) ◽  
pp. 189-194 ◽  
Author(s):  
L.V. McFarland
Keyword(s):  
Clostridium Difficile ◽  
Protective Efficacy ◽  
Meta Analysis ◽  
Lactobacillus Rhamnosus ◽  
Saccharomyces Boulardii ◽  
Clinical Practices ◽  
Therapeutic Decisions ◽  
Different Types ◽  
Meta Analyses ◽  
Antibiotic Associated Diarrhoea

Meta-analyses are used to evaluate pooled effects of a wide variety of investigational agents, but the interpretation of the results into clinical practices may be difficult. This mini-review offers a three-step process to enable healthcare providers to decipher pooled meta-analysis estimates into results that are useful for therapeutic decisions. As an example of how meta-analyses should be interpreted, a recent meta-analysis of probiotics for the prevention of paediatric antibiotic-associated diarrhoea (AAD) and the prevention of Clostridium difficile infections (CDI) will be used. First, the pooled results of this meta-analysis indicates a significant protective efficacy for AAD is found when the 16 different types of probiotics are combined (pooled relative risk (RR) = 0.43, 95% confidence interval (CI)=0.33-0.56) and also a significant reduction of paediatric CDI (pooled RR=0.34, 95%CI=0.16-0.74) was found pooling four different types of probiotics. Secondly, because the efficacy of probiotics is strain-specific, it is necessary to do a sensitivity analysis, restricting the meta-analysis to one specific strain. Two strains, Saccharomyces boulardii lyo and Lactobacillus rhamnosus GG showed significant efficacy for paediatric AAD when pooled (pooled RR for S. boulardii = 0.43, 95%CI=0.21-0.86 and pooled RR for L. rhamnosus GG = 0.44, 95%CI=0.20-0.95). Thirdly, if studies within probiotic types have different results, it is prudent to examine these studies individually to determine the reasons why non-significant differences in efficacy were found. By drilling down through these three analytic layers, physicians will be confident in recommending the correct probiotic strain to their patients.

scholarly journals Potion or Poison? Probiotics

2013 ◽  
Vol 5 (1) ◽  
pp. 81 ◽  
Author(s):  
Shane Scahill
Keyword(s):  
Clostridium Difficile ◽  
Antibiotic Therapy ◽  
Clinical Benefit ◽  
Lactobacillus Rhamnosus ◽  
Saccharomyces Boulardii ◽  
Insufficient Evidence ◽  
Probiotic Lactobacillus ◽  
High Doses ◽  
Antibiotic Associated Diarrhoea

SUMMARY MESSAGE: Two types of probiotic (Lactobacillus rhamnosus and Saccharomyces boulardii) at high doses may prevent the onset of antibiotic-associated diarrhoea in children. Probiotics are generally well tolerated. Clinical benefit needs to be confirmed in larger studies across a greater range of probiotics. There is insufficient evidence to recommend probiotic therapy in adults as an adjunct to antibiotic therapy, specifically for Clostridium difficile-induced colitis.

Probiotics for Clostridium difficile–Associated Diarrhea: Focus on Lactobacillus rhamnosus GG and Saccharomyces boulardii

2007 ◽  
Vol 41 (7-8) ◽  
pp. 1212-1221 ◽  
Author(s):  
Marisel Segarra-Newnham
Keyword(s):  
Clostridium Difficile ◽  
Case Reports ◽  
Data Extraction ◽  
Meta Analysis ◽  
Lactobacillus Rhamnosus ◽  
Case Series ◽  
Saccharomyces Boulardii ◽  
First Episode ◽  
Lactobacillus Rhamnosus Gg ◽  
Clostridium Difficile Associated Diarrhea

Objective: To review the literature on the use of probiotics to treat or prevent recurrences of Clostridium difficile-associated diarrhea (CDAD) by replacing normal gastric flora. Data Sources: PubMed (1970–March 2007) was searched using the terms probiotics, Clostridium difficile, colitis, diarrhea, prevention, and treatment. Study Selection and Data Extraction: Case reports, case series, and clinical trials describing the use of probiotics in the treatment or prevention of recurrences of CDAD as primary outcome were included. Data Synthesis: A variety of controlled trials, case series, and case reports have evaluated probiotics to treat first or recurrent episodes of CDAD. In addition, a meta-analysis has been conducted to try to determine the rote of probiotics in CDAD. In general, most case series and case reports have shown favorable results with Lactobacillus rhamnosus GG or Saccharomyces boulardii. However, other reports have shown lack of benefit. The meta-analysis showed that these probiotics may be useful in treating or preventing recurrences of CDAD. Nonetheless, the heterogeneity of the studies makes definite conclusions difficult. In addition, several cases of bacteremia or fungemia associated with probiotic use have been reported, particularly in the last decade. Patients most commonly affected by these complications are immunosuppressed. Unfortunately, these are also the patients more likely to have severe CDAD or are at risk for recurrences. Conclusions: Additional experience with and study of probiotics are warranted due to numerous unanswered questions. Given the potential for complications in debilitated and immunosuppressed patients, the risks may outweigh benefits, and rational antibiotic use may be a better option to prevent a first episode or recurrence of CDAD.

scholarly journals A Statistical Method for Synthesizing Meta-Analyses

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Liansheng Larry Tang ◽  
Michael Caudy ◽  
Faye Taxman
Keyword(s):  
Statistical Method ◽  
Effect Size ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Weighted Mean ◽  
Summary Effect ◽  
Different Types ◽  
Meta Analyses ◽  
Size Estimates ◽  
Similar Search

Multiple meta-analyses may use similar search criteria and focus on the same topic of interest, but they may yield different or sometimes discordant results. The lack of statistical methods for synthesizing these findings makes it challenging to properly interpret the results from multiple meta-analyses, especially when their results are conflicting. In this paper, we first introduce a method to synthesize the meta-analytic results when multiple meta-analyses use the same type of summary effect estimates. When meta-analyses use different types of effect sizes, the meta-analysis results cannot be directly combined. We propose a two-step frequentist procedure to first convert the effect size estimates to the same metric and then summarize them with a weighted mean estimate. Our proposed method offers several advantages over existing methods by Hemming et al. (2012). First, different types of summary effect sizes are considered. Second, our method provides the same overall effect size as conducting a meta-analysis on all individual studies from multiple meta-analyses. We illustrate the application of the proposed methods in two examples and discuss their implications for the field of meta-analysis.

scholarly journals Comparison of different approaches to antibiotic restriction in food-producing animals: stratified results from a systematic review and meta-analysis

2019 ◽  
Vol 4 (4) ◽  
pp. e001710 ◽  
Author(s):  
Karen L Tang ◽  
Niamh P Caffrey ◽  
Diego B Nóbrega ◽  
Susan C Cork ◽  
Paul E Ronksley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antibiotic Resistance ◽  
Meta Analysis ◽  
Antibiotic Use ◽  
Growth Promoter ◽  
Antibiotic Resistant ◽  
Random Effects Models ◽  
Differential Effectiveness ◽  
Different Types ◽  
Meta Analyses

BackgroundWe have previously reported, in a systematic review of 181 studies, that restriction of antibiotic use in food-producing animals is associated with a reduction in antibiotic-resistant bacterial isolates. While informative, that report did not concretely specify whether different types of restriction are associated with differential effectiveness in reducing resistance. We undertook a sub-analysis of the systematic review to address this question.MethodsWe created a classification scheme of different approaches to antibiotic restriction: (1) complete restriction; (2) single antibiotic-class restriction; (3) single antibiotic restriction; (4) all non-therapeutic use restriction; (5) growth promoter and prophylaxis restriction; (6) growth promoter restriction and (7) other/undetermined. All studies in the original systematic review that were amenable to meta-analysis were included into this substudy and coded by intervention type. Meta-analyses were conducted using random effects models, stratified by intervention type.ResultsA total of 127 studies were included. The most frequently studied intervention type was complete restriction (n=51), followed by restriction of non-therapeutic (n=33) and growth promoter (n=19) indications. None examined growth promoter and prophylaxis restrictions together. Three and seven studies examined single antibiotic-class and single antibiotic restrictions, respectively; these two intervention types were not significantly associated with reductions in antibiotic resistance. Though complete restrictions were associated with a 15% reduction in antibiotic resistance, less prohibitive approaches also demonstrated reduction in antibiotic resistance of 9%–30%.ConclusionBroad interventions that restrict global antibiotic use appear to be more effective in reducing antibiotic resistance compared with restrictions that narrowly target one specific antibiotic or antibiotic class. Importantly, interventions that allow for therapeutic antibiotic use appear similarly effective compared with those that restrict all uses of antibiotics, suggesting that complete bans are not necessary. These findings directly inform the creation of specific policies to restrict antibiotic use in food-producing animals.

Happy birthday neuroleptics! 50 years later: la folie du doute

2002 ◽  
Vol 17 (3) ◽  
pp. 115-119 ◽  
Author(s):  
Emmanuel Stip
Keyword(s):  
Meta Analysis ◽  
D2 Receptor ◽  
Good Deal ◽  
Theoretical Models ◽  
Clinical Practices ◽  
Initial Report ◽  
50Th Birthday ◽  
Meta Analyses ◽  
Based Medicine ◽  
New Compounds

SummaryGiven that we are celebrating the 50th birthday of neuroleptics introduction in psychiatry, the author proposes to take a look at certain results related to therapeutic practice. After a brief chronological literature review of the clinical practices and theoretical models that have controlled drug treatment of schizophrenia, the author presents a critical review of four meta-analyses. Since Delay, Deniker and Harl’s initial report, the story of neuroleptics comprises several periods. In 1963, the hyper-dopaminergic theory of psychoses was proposed. Another period began with models mainly based on the serotonin/dopamine relative blockade receptor hypothesis. More recently, a new framework to understand the differential effect of antipsychotics is related to the appropriate modulation (e.g., fast dissociation) of the D2 receptor alone. The concept of atypicality has become a new vista for research and to market new compounds. However, after 50 years of neuroleptic drugs, are we able to answer the following simple questions: Are neuroleptics effective in treating schizophrenia? Is there a difference between atypical and conventional neuroleptics? How do the efficacy and safety of newer antipsychotic drugs compare with those of clozapine? Actually, the answers yielded by these simple questions by meta-analysis should elicit in us a good deal of humility. If we wish to base psychiatry on evidence-based medicine, we run a genuine risk in taking a closer look at what has long been considered fact. Each psychiatrist must continue to be critical, sceptical, optimistic (not overoptimistic) and to learn in order to integrate the positive aspects of our growing knowledge base.

Meta-analysis: A 12-step program

2003 ◽  
Author(s):  
L. Streiner David
Keyword(s):  
Meta Analysis ◽  
Effect Sizes ◽  
Prevalence Rates ◽  
Global Estimate ◽  
Different Types ◽  
Comprehensive Search ◽  
Meta Analyses ◽  
Explicit Criteria ◽  
Step Program

Meta-analysis is a technique for combining the results of many studies in a rigorous and systematic manner, to allow us to better assess prevalence rates for different types of gambling and determine which interventions have the best evidence regarding their effectiveness and efficacy. Meta-analysis consists of (a) a comprehensive search for all available evidence; (b) the use of applying explicit criteria for determining which articles to include; (c) determination of an effect size for each study; and (d) the pooling of effect sizes across studies to end up with a global estimate of the prevalence or the effectiveness of a treatment. This paper begins with a discussion of why meta-analyses are useful, followed by a 12-step program for conducting a meta-analysis. This program can be used both by people planning to do such an analysis, as well as by readers of a meta-analysis, to evaluate how well it was carried out.

scholarly journals Exercise versus Metformin to Improve Pregnancy Outcomes among Overweight Pregnant Women: A Systematic Review and Network Meta-Analysis

2021 ◽  
Vol 10 (16) ◽  
pp. 3490
Author(s):  
Carlos Pascual-Morena ◽  
Iván Cavero-Redondo ◽  
Celia Álvarez-Bueno ◽  
Maribel Lucerón-Lucas-Torres ◽  
Gema Sanabria-Martínez ◽  
...  
Keyword(s):  
Aerobic Exercise ◽  
Pregnant Women ◽  
Web Of Science ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Maternal Weight ◽  
Overweight Women ◽  
Randomized Controlled ◽  
Different Types ◽  
Meta Analyses

Being overweight is associated with pregnancy-related disorders such as gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), and excessive maternal weight gain (MWG). Exercise and metformin reduce the risk of these disorders. This network meta-analysis (NMA) aims to compare the effect of metformin and different types of exercise (aerobic, resistance and combined) on the risk of GDM, HDP, and MWG among overweight/obese pregnant women. Medline, EMBASE, Web of Science and Cochrane Library were searched from inception to June 2021. Meta-analyses and NMAs were performed. Sixteen randomized controlled trials were included. In the NMA, aerobic exercise showed an effect on GDM (RR = 0.51, 95% CI = 0.26, 0.97), and metformin a reduction in MWG (MWG = −2.93 kg, 95% CI = −4.98, −0.87). No intervention showed any effect on the reduction of HDP. Our study suggests that aerobic exercise may have the greatest effect in reducing the risk of GDM, and perhaps, the MWG. Strategies should be developed to increase adherence to this type of intervention among overweight women without contraindications. Although metformin could reduce MWG, medicalization of pregnancy in healthy women is not justified with the present results. More research is needed on the effect of the intensity and frequency of exercise sessions and the length of interventions.

First Steps in Beginning a Meta-analysis

2013 ◽  
Author(s):  
Gavin B. Stewart ◽  
Isabelle M. Côté ◽  
Hannah R. Rothstein ◽  
Peter S. Curtis
Keyword(s):  
Field Experiment ◽  
Systematic Approach ◽  
Sampling Error ◽  
Meta Analysis ◽  
Research Synthesis ◽  
Systematic Research ◽  
Different Types ◽  
Statistical Approaches ◽  
Definition Of ◽  
Meta Analyses

This chapter discusses the initiation of the process of systematic research synthesis. Without a systematic approach to defining, obtaining, and collating data, meta-analyses may yield precise but erroneous results, with different types of sampling error (biases) and excess subjectivity in choice of methods and definition of thresholds; these devalue the rigor of any statistical approaches employed. The chapter considers exactly the same issues that face an ecologist designing a field experiment. What's the question? How can I define my sampling universe? How should I collect my data? What analyses should I undertake? How should I interpret my results robustly? These questions are considered in the context of research synthesis.

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