Nancy Toedter Williams

Disclosures

Am J Health Syst Pharm. 2010;67(6):449-458. 

In This Article

Acute Diarrhea

There is convincing evidence from multiple studies supporting the efficacy of probiotics in the treatment of acute diarrhea, especially in children with rotavirus infection. The probiotics most frequently studied for treating acute diarrhea include LGG and Lactobacillus reuteri.[2,7,15,17] The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition conducted a double-blind, placebo-controlled, multicenter study involving 287 children age 1–36 months from 10 countries who were admitted to the hospital with moderate-to-severe diarrhea, most commonly due to rotavirus or an unknown pathogen.[25] The patients were randomized to receive oral re-hydration solution plus placebo or oral rehydration solution plus a live preparation of LGG. Patients who were given LGG versus placebo had a shorter mean ±S.D. duration of diarrhea (58.3 ± 27.6 hours versus 71.9 ± 35.8 hours, p = 0.03) and a shorter hospital stay (78.8 ± 22.2 hours versus 96.3 ± 21.4 hours, p = 0.04). In addition, patients treated with LGG were less likely to have persistent diarrhea (i.e., diarrhea lasting longer than seven days) (2.7% versus 10.7% of those receiving placebo, p < 0.01).

Van Niel et al.[26] conducted a meta-analysis of nine clinical trials (n = 765) involving children younger than three years with acute infectious diarrhea who received Lactobacillus species, most frequently LGG. The studies examined were randomized, blinded, controlled trials that measured diarrhea duration and the frequency of diarrheal stools on the second day of treatment. The meta-analysis revealed a reduced mean duration of diarrhea by 0.7 day (95% confidence interval [CI], 0.3–1.2 days) and a decrease in diarrhea frequency by a mean of 1.6 stools per day on day 2 of treatment (95% CI, 0.7–2.6 fewer stools) in children who received probiotics.

All probiotics are not equally effective in treating acute diarrhea in children. Canani et al.[27] illustrated this point and emphasized that the particular probiotic preparation should be chosen based on solid efficacy data. In their study, 571 children age 3–36 months with acute diarrhea were randomized to one of six different treatment groups: oral rehydration solution alone (control group) or one of five probiotic preparations, which were prescribed for five days. Only two preparations—LGG and a mixture of four bacterial strains (Lactobacillus delbrueckii var bulgaricus, Streptococcus thermophilus, Lactobacillus acidophilus, and Bifidobacterium bifidum)—were associated with a significantly shorter median duration of diarrhea (78.5 and 70 hours, respectively; p < 0.001) compared with children who received oral rehydration solution alone (115.5 hours). One day after initiation of probiotics, children who were given LGG or the probiotic mixture also had a significantly lower daily stool output compared with the other groups (p < 0.001). The other three preparations (S. boulardii, Bacillus clausii, and Enterococcus faecium SF 68) did not significantly affect the duration and severity of diarrhea.

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