COMMENTARY

5 Best of 2019: Most-Read Pediatrics Viewpoints

William T. Basco, Jr, MD, MS

Disclosures

January 21, 2020

#2: Probiotics: Use 'em or Lose 'em?

Although probiotics are widely used, both in adults and children, there are limited rigorous trial data examining their efficacy, particularly in young children. A recent study specifically sought to better understand their role in the treatment of acute gastroenteritis (AGE).

In a study conducted in 10 pediatric emergency departments (EDs), approximately 1000 children between the ages of 3 months and 4 years with AGE were randomly assigned to receive either Lactobacillus rhamnosus GG or a similar-appearing placebo for 5 days. Just under half—45%—of all the children had stool testing positive for a virus. An additional 15% had a bacterial stool infection, and 1.2% a parasitic infection. Moderate to severe AGE developed by day 14 in just over 10% of children in each group. Differences between the treatment and control groups in secondary outcomes, such as fever, duration of diarrhea or vomiting, hospitalization, parental missed work, and need for healthcare visits, were also minimal for children in all age groups.

Viewpoint

Practicing pediatric providers face weekly, if not daily, questions from parents as to the value of probiotics. It would be wonderful if a simple, safe treatment that could improve the course of AGE were available, allowing providers and parents an option that is more therapeutic than "supportive care." However, a second trial using very similar methods tested a combination product containing Lactobacillus rhamnosus R0011 augmented with a small amount of Lactobacillus helveticus R0052 and also failed to demonstrate effectiveness.

The findings of these two recent trials are very different from those of previous trials summarized in a well-publicized Cochrane review, leaving clinicians and parents in a bit of limbo. And, as noted in a recent review of the data, the potential benefits may be limited to specific strains for specific conditions (eg, AGE versus antibiotic-induced diarrhea).

On the positive side, children in the trials experienced few adverse events, suggesting that parents who try probiotic products on their own may not be creating any risk for their children.

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