Efficacy of Shenlingbaizhusan for antibiotic-associated diarrhea: A systematic review and meta-analysis

Objective: This systematic review and meta-analysis evaluated the efficacy of Shenlingbaizhusan (SLBZS) for antibiotic-associated diarrhea (AAD). Methods: Scientific databases such as PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese National Knowledge Infrastructure (CNKI), the Chongqing VIP information, the Wan -fang, and the SinoMed (CBM), were searched to identify randomized control trials (RCTs) relevant to SLBZS use in AAD. The search items included "antibiotic-associated diarrhea," "Shenlingbaizhusan," and "random." There were no limits on gender, race, or disease stage. RCTs of SLBZS combined with conventional treatment versus conventional treatment alone were eligible. Results: Eight RCTs involving 774 participants were included. Two reviewers independently extracted the data and analyzed them using Review Manager 5.3 software. The GRADEpro Guideline Development Tool generated the summary of the findings table. For AAD, adding SLBZS to conventional therapy achieved higher clinical efficacy rate (RR=1.19, 95CI %[1.12-1.25], P < 0.00001), shorter duration of frequency of diarrhea (MD =-2.38 [-2.67,-2.09], P < 0.00001), shorter duration of character of stool (MD =-2.43[-3.03,-1.84], P < 0.00001), shorter duration of bowel sound, higher peripheral blood CD3+ count, higher peripheral blood CD4+ count (MD=5.04 [4.28, 5.80], P < 0.00001), higher peripheral blood CD4+/CD8+ ratio (MD = 0.35 [0.24, 0.47], P < 0.00001), and lower peripheral blood CD8+ count (MD =-2.88 [-3.73,-2.02], P < 0.00001). No trials reported serious adverse events. Even then, the level of evidence was "low" or "very low" because of its small sample size, risk of bias, and imprecision. Conclusion: SLBZS is beneficial to patients with AAD. However, more high-quality RCTs with larger sample sizes are needed to confirm and fully elucidate the efficacy of SLBZS.