What is the efficacy of probiotics in the treatment of diarrhea?

Updated: Jan 31, 2020
  • Author: Stefano Guandalini, MD; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Recently, some strains of probiotics (defined as live microorganisms that when ingested in adequate doses, provide a benefit to the host) have been found to be effective as an adjunct when treating children with acute diarrhea. Data from well-conducted randomized controlled trials on efficacy of probiotics in children with diarrhea are definitely positive. They consistently show a statistically significant benefit and moderate clinical benefit of a few, now well-identified probiotic strains (mostly Lactobacillus GG and Saccharomyces boulardii but also Lactobacillus reuteri) in the treatment of acute watery diarrhea (primarily rotaviral) in infants and young children in developed countries.

Such a beneficial effect seems to result in a reduction of the duration of diarrhea of about one day and seems to be exerted mostly on rotaviral diarrhea, with much less evidence of efficacy in invasive bacterial diarrhea. The effect is not only strain-dependent but also dose-dependent, with doses of at least 5 billion/d being required for effect. [14] Shortening the duration of diarrhea by one day may not appear to be hugely beneficial. However, in consideration of the high morbidity of the infection, even a reduction of this order is indeed desirable because it affords considerable savings in terms of loss of working days and direct health costs.

Furthermore, probiotics may reduce the risk of spreading rotavirus infection by shortening diarrhea duration and volume of watery stool output and by reducing the fecal shedding of rotavirus, and they have been found useful in preventing the dissemination of hospital-acquired diarrheas.

A recent position paper jointly published by the ESPGHAN and the European Society for Pediatric Infectious Disease (ESPID) stated, ‘‘Probiotics may be an effective adjunct to the management of diarrhea. However, because there is no evidence of efficacy for many preparations, we suggest the use of probiotic strains with proven efficacy and in appropriate doses for the management of children with acute gastroenteritis as an adjunct to rehydration therapy (II, B). The following probiotics showed benefit in meta-analyses of randomized controlled trials: Lactobacillus GG (I, A) and S boulardii (II, B).’’

Table 5 illustrates current assessment of the efficacy of probiotics in conditions characterized by diarrhea.

Table 5. Probiotic Efficacy in Diarrhea (Open Table in a new window)

Condition

Patients and Controls

Most-Studied Probiotics

Evidence of Efficacy

(- to +++)

Prevention of Daycare Diarrhea

2000

Lactobacillus GG

Bifidobacterium lactis

Lactobacillus reuteri

Lactobacillus casei

Bifidobacterium bifidum + Streptococcus thermophilus

+

Prevention of Nosocomial Diarrhea

1000

Lactobacillus GG

++

Prevention of Antibiotic-Associated Diarrhea

2000

Lactobacillus GG

Saccharomyces boulardii

+++

Infectious Diarrhea

3500

Lactobacillus GG

Saccharomyces boulardii

+++

Persistent Diarrhea

460

Lactobacillus GG

+


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