Probiotics and the Treatment of Infectious Diarrhea

Jonathan E. Teitelbaum, MD


Pediatr Infect Dis J. 2005;24(3):267-268. 

In This Article

Bacterial Diarrhea, Including Traveler's Diarrhea

Overall results of studies of probiotics for use in treatment or prevention of bacterial diarrhea, other than C difficile , are mixed. Many studies have evaluated the efficacy of probiotics in preventing traveler's diarrhea. In a study of 820 travelers to 2 resorts in Turkey, LGG failed to affect the overall rate of diarrhea (43% of controls versus 38% in the LGG). However, in 1 resort, the diarrhea rate was 40% for controls compared with 24% of the LGG-treated travelers.[12] In a second study, travelers were monitored by a hospital-based Travel and Immunization Center. Destinations varied and compliance with the study drug (placebo or LGG) was good in 245 participants. Overall the incidence of traveler's diarrhea averaged 7.4%/d for the placebo group and 3.9%/d for the probiotic group.[13] In a study of healthy volunteers fed enterotoxigenic Escherichia coli , there was no benefit from concurrent administration of lactobacilli.[14] Results of other studies of probiotics alone or in combination for prevention of traveler's diarrhea are conflicting. Cost-benefit analysis studies are needed to determine whether a marginal reduction in traveler's diarrhea warrants treatment of all travelers.

The effects of probiotics for other pathogenic bacteria are variable. A study of E faecium in 183 Bangladeshi adults with acute diarrhea caused by Vibrio cholera , enterotoxigenic Escherichia coli or unknown organisms did not shown efficacy.[15] Although some studies with L. acidophilus have shown an effect against bacterial causes of enteritis and Bifidobacterium breve has been somewhat effective against Campylobacter , most studies of probiotics for treatment of patients with bloody diarrhea have not shown a benefit.