Probiotics for Prevention and Treatment of Diarrhea

Abstract

Probiotics are increasingly used for prevention and treatment of diarrhea more in children than in adults. Given the broad spectrum of diarrhea, this review focuses on the main etiologies: acute gastroenteritis, antibiotic-associated diarrhea (AAD), and necrotizing enterocolitis (NEC). For each, we reviewed randomized controlled trials, meta-analyses, and guidelines. For acute gastroenteritis we found 12 guidelines: 5 recommended probiotics and 7 did not. However, the guidelines containing positive recommendations provided proof of evidence from clinical trials and meta-analyses. Lactobacillus rhamnosus GG (LGG) and Saccharomyces boulardii had the most compelling evidence of efficacy as they reduced the duration of the disease by 1 day. For AAD 4 meta-analyses were found, reporting variable efficacy of probiotics in preventing diarrhea, based on the setting, patient's age, and antibiotics. The most effective strains were LGG and S. boulardii. For NEC, we found 3 randomized controlled trials, 5 meta-analyses, and 4 position papers. Probiotics reduced the risk of NEC enterocolitis and mortality in preterm babies. Guidelines did not support a routine use of probiotics and asked for further data for such sensitive implications. In conclusion, there is strong and solid proof of efficacy of probiotics as active treatment of gastroenteritis in addition to rehydration. There is solid evidence that probiotics have some efficacy in prevention of AAD, but the number needed to treat is an issue. For both etiologies LGG and S. boulardii have the strongest evidence. In NEC the indications are more debated, yet on the basis of available data and their implications, probiotics should be carefully considered.

Open Clinical Trial on Using Nifuroxazide Compared to Probiotics in Treating Acute Diarrhoeas in Adults

“…However, after performing the stratification on children and adults age groups, there is statistically significant difference in pediatric population compared to adults where probiotics shown efficacy in subgroup of patients treated with antibiotics in eradication therapy of Helicobacter pylori. This study once again confirms the insufficiency of research results in adult population 14,15…”

Characterization of Fecal Microbiota of Children With Diarrhea in 2 Locations in Colombia

“…Delivery of dietary probiotics has been hypothesized as a strategy to prevent diarrhea (17) or as an adjuvant to improve vaccine efficacy (18). Several meta-analyses have suggested that Lactobacillus and Bifidobacterium species may be effective in prevention of gastroenteritis (17,(19)(20)(21); however, randomized controlled trials conducted mostly in childcare centers from affluent countries have indicated only a modest benefit in preventing acute gastrointestinal infections in healthy infants and children (22)(23)(24). Limited and variable outcomes from communitybased trials in developing countries suggested some benefit when certain Lactobacillus species were used to prevent the onset of diarrhea (21,25,26).…”

Clinical Practice Guideline for the Treatment of Pediatric Acute Gastroenteritis in the Outpatient Setting

“…Despite a lack of consensus regarding treatment of pediatric patients who have AGE with probiotics, findings from clinical trials support the use of probiotics to decrease the duration and intensity of AGE (Guarino, Guandalini, & Lo Vecchio, 2015). The quality of evidence on probiotics is low, and additional research should be conducted to strengthen evidence.…”