Meta-analysis finds Bacillus subtilis and Enterococcus faecium reduce antibiotic-associated diarrhea

Photo by National Institute of Allergy and Infectious Diseases / Unsplash

The Tohoku journal of experimental medicine Published May 14, 2026 Medically reviewed May 14, 2026 Study authors: Zhang Na, Chen Yongshan, Shen Zhenyu PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider adding LCBE to symptomatic therapy for antibiotic-associated diarrhea, but note unreported safety data.

This meta-analysis of randomized controlled trials assessed the efficacy of live combined Bacillus subtilis and Enterococcus faecium (LCBE) plus symptomatic therapy compared with symptomatic therapy alone for antibiotic-associated diarrhea. The analysis included 2919 cases in the experimental group and 2781 cases in the control group, encompassing both pediatric and adult patients undergoing antibiotic treatment.

The primary outcomes were total effective rate, time to relief of symptom, and incidence of diarrhea. LCBE plus symptomatic therapy was associated with a significantly higher total effective rate (OR 6.541, 95% CI: 4.850 to 8.822, P < 0.001), a shorter time to symptom relief (mean difference -1.798 days, 95% CI: -2.364 to -1.232, P < 0.001), and a lower incidence of diarrhea (OR 0.275, 95% CI: 0.234 to 0.324, P < 0.001) compared with symptomatic therapy alone.

Notably, adverse events, serious adverse events, discontinuations, and tolerability were not reported in the included studies, which limits the assessment of safety. The authors did not explicitly discuss limitations, but the absence of safety data is a significant gap. The meta-analysis did not report on funding or conflicts of interest.

For clinicians, these findings suggest that adding LCBE to symptomatic therapy may improve outcomes in antibiotic-associated diarrhea, but the lack of safety information warrants caution. Further studies with comprehensive safety reporting are needed before routine clinical recommendation.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

PMID41125358

View Original Abstract ↓

Live Combined Bacillus subtilis and Enterococcus faecium (LCBE) is a pioneer probiotic restoring intestinal microecological balance by improving anaerobic environment. This randomized controlled trial (RCT)-based meta-analysis intended to comprehensively explore the efficacy of LCBE in treating and preventing antibiotic-associated diarrhea (AAD) in pediatric and adult patients undergoing antibiotic treatment. A comprehensive search was performed in Cochrane Library, PubMed, Web of Science, China Science and Technology Journal Database, Wan Fang, and China National Knowledge Infrastructure from establishment to December 2, 2024. The treatment efficacy (reflected by total effective rate and time to relief of symptom) and preventive efficacy (reflected by incidence of diarrhea) for AAD were assessed. Thirty-three studies involving 2919 cases with LCBE plus symptomatic therapy (experimental group) and 2781 cases with symptomatic therapy alone (control group) were included. Experimental group reached a higher total effective rate [odds ratio (OR) {95% confidence interval (CI)}: 6.541 (4.850, 8.822), P < 0.001], shorter time to relief of symptom [mean difference (95% CI): -1.798 (-2.364, -1.232) days, P < 0.001], and lower incidence of diarrhea [OR (95% CI): 0.275 (0.234, 0.324), P < 0.001] vs. control group. Subgroup analyses based on LCBE granule and capsule form showed similar results. All studies were high-quality and there was no publication bias reflected by ROB 2.0 tool and Begg's test analyses, respectively. Sensitivity analyses indicated high robustness. In conclusion, LCBE increases total effective rate (OR = 6.541) for AAD treatment and decreases diarrhea risk (OR = 0.275) for AAD prevention, which may be a promising probiotic for pediatric and adult patients undergoing antibiotic treatment.