Systematic Review on Traditional Chinese Herbal Medicine Treatment for Antibiotic Associated Diarrhea

항생제 연관성 설사의 중의약 치료 효과에 대한 체계적 고찰

  • Received : 2017.09.14
  • Accepted : 2017.09.28
  • Published : 2017.10.31


Objectives To summarize and evaluate the efficacy of traditional Chinese herbal medicine (TCHM) treatment for antibiotic associated diarrhea (AAD). Methods Eight electronic databases were searched from their inception to August 2017. Randomized controlled trials (RCTs) assessing the efficacy of TCHM treatment for AAD were included. The risk of bias was assessed using the Cochrane risk of bias assessment tool. Data analysis was performed using RevMan software version 5.3. Results Seventeen RCTs involving 1138 patients with AAD were included for qualitative synthesis. TCHM treatment improved total effective rate (TER). However, the results that TER in experimental group was significantly higher than in control group were different between the included studies. TCHM enema treatment improved TER, but not significantly higher than control group. The most frequently used herbal formulas were Gamiwekwanjeon, Gamiinsampaedoksan, and Samryungbaekchulsan. The most frequently used TCHMs were Atractylodes macrocephala (Bai Zhu), Dioscorea batatas (Shan Yao). Within the studies documenting the adverse events, no serious adverse events associated with TCHM treatment were observed. Conclusions Evidence of TCHM treatment efficacy for AAD is encouraging, but not conclusive, because of the low methodological qualities, diversity of TCHM treatment prescriptions. Further well-designed RCTs with rigorous randomization and blinding method are needed to confirm these results.


Antibiotic associated diarrhea;Clostridium difficile;Herb;Traditional Chinese medicine


  1. Blaser M. Antibiotic overuse: Stop the killing of beneficial bacteria. Nature. 2011;476(7361):393-4.
  2. Redelings MD, Sorvillo F, Mascola L. Increase in Clostridium difficile-related mortality rates, United States, 1999-2004. Emerging infectious diseases. 2007;13(9): 1417-9.
  3. Napolitano LM, Edmiston CE, Jr. Clostridium difficile disease: Diagnosis, pathogenesis, and treatment update. Surgery. 2017;162(2):325-48.
  4. Spigaglia P. Recent advances in the understanding of antibiotic resistance in Clostridium difficile infection. Therapeutic advances in infectious disease. 2016;3(1): 23-42.
  5. Vonberg RP, Reichardt C, Behnke M, Schwab F, Zindler S, Gastmeier P. Costs of nosocomial Clostridium difficile-associated diarrhoea. The Journal of hospital infection. 2008;70(1):15-20.
  6. Aljarallah KM. Conventional and alternative treatment approaches for Clostridium difficile infection. International journal of health sciences. 2017;11(1):1-10.
  7. Chen F, Liu J, Yu F, Xu J, Wang Q, Chen Z, et al. Treatment of 32 cases of antibiotic associated diarrhea by Taohua Tang. Zhejiang Journal of Traditional Chinese Medicine. 2017;52(6):421.
  8. Deng T. Clinical research on new Baizhu San in the teatment of neonatal antibiotic associated diarrhea (Spleen deficiency syndrome). Hunan University of Traditional Chinese Medicine. 2017:5-44.
  9. Duan S-H. Retention-enema treatment of severe antibiotic associated diarrhea:a clinical analysis. Chinese Journal of Nosocomiology. 2011;21(8):1654-6.
  10. Gao J. Clinical research on dialectical classify treatments of TCM for ICU antibiotic-associated diarrhea. Chengdu University of Traditional Chinese Medicine. 2011:1-76.
  11. Gao P, He C, Hung X, Zhang C. Clinical observation on TCM comprehensive treatment for 46 cases of antibiotic-associated diarrhea. Journal of Traditional Chinese Medicine. 2013;54(11):932-8.
  12. Li J. Clinical study of treatment of antibiotic-associated diarrhea by traditional Chinese medicine. Bright Healthcare Traditional Chinese Medicine. 2013;28(1):97-8.
  13. Liu D-M. Clinical study of decoction of Chang-ning on senile antibiotic-associated diarrhea. Shanxi Journal of Traditional Chinese Medicine. 2013;29(6):43-5.
  14. Mao Y. Clinical study of antibiotic-associated diarrhea in children treated by TCM syndrome differentiation. Heilongjiang Journal of Traditional Chinese Medicine. 2010;6:22-3.
  15. Meng S, Guo Y, Zhang Y, Bao H, Tian Y, Wang T, et al. Treatment of 32 elderly patients with antibiotic-associated diarrhe by Warming up Yang-qi and Stopping diarrhea Journal of Emergency in Traditional Chinese Medicine. 2010;19(8):1402-3.
  16. Tang W. Clinical research on synthesized TCM treatment for antibiotic-associated diarrhea. Chengdu University of Traditional Chinese Medicine. 2011:1-60.
  17. Wang T. Clinical effect of combined treatment of traditional Chinese medicine and Western medicine for antibiotic associated diarrhea patients. Bright Healthcare Traditional Chinese Medicine. 2008;23(2):180.
  18. Wang K. Curative effect of Zi Ni Xing Pi Yang Wei Tang enema treatment on children with antibiotic associated diarrhea. Shandong University of Traditional Chinese Medicine. 2013:1-28.
  19. Wang R, Wu L, Li H. Clinical observation of Sishen Jiawei decoction in treating antibiotic associated diarrhea Chinese Journal of Chinese Medicine. 2016;8(6):69-70.
  20. Xie X, Peng Y. Clinical study of Si Jun Zi decoction in treating 36 cases of antibiotic associated diarrhea. Journal of Guiyang College of Traditional Chinese Medicine. 2011;33(2):56-8.
  21. Yu BL. Treatment of 30 cases of cerebral stroke with antibiotic associated diarrhea by traditional Chinese medicine. Journal of Emergency in Traditional Chinese Medicine. 2009;18(5):808-9.
  22. Yue A. Changningtang in the treatment of 66 cases of elderly patients with antibiotic associated diarrhea. Chinese Medicine and Pharmacy. 2015;5(15):77-9.
  23. Zhang Y, Gao J, Gao P, Zhang X. Clinical effects of Chinese medicine for 45 cases of antibiotic associated diarrhea patients in ICU. Journal of Sichuan Traditional Chinese Medicine. 2012;30(6):85-6.
  24. Roshan N, Riley TV, Hammer KA. Antimicrobial activity of natural products against Clostridium difficile in vitro. Journal of applied microbiology. 2017;123:92-103.
  25. Lv Z, Peng G, Liu W, Xu H, Su J. Berberine blocks the relapse of Clostridium difficile infection in C57BL/6 mice after standard vancomycin treatment. Antimicrobial agents and chemotherapy. 2015;59(7):3726-35.
  26. Lv W, Liu C, Ye C, Sun J, Tan X, Zhang C, et al. Structural modulation of gut microbiota during alleviation of antibiotic-associated diarrhea with herbal formula. International journal of biological macromolecules. 2017.
  27. Ya-Nan G, Jun W, Hao-Jun Z, Hong-Bing J, Ping L, Xin-Zhu L. Traditional Chinese Medicine QPYF as Preventive Treatment for Clostridium difficile Associated Diarrhea in a Mouse Model. Evidence-based complementary and alternative medicine : eCAM. 2016;2016: 3759819.


Supported by : 한국연구재단