Probiotics for treating acute infectious diarrhoea

Abstract

BACKGROUND: Probiotics may offer a safe intervention in acute infectious diarrhoea to reduce the duration and severity of the illness.OBJECTIVES: To assess the effects of probiotics in proven or presumed acute infectious diarrhoea.SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group's trials register (July 2010), the Cochrane Controlled Trials Register (The Cochrane Library Issue 2, 2010), MEDLINE (1966 to July 2010, EMBASE (1988 to July 2010), and reference lists from studies and reviews. We also contacted organizations and individuals working in the field, and pharmaceutical companies manufacturing probiotic agents.SELECTION CRITERIA: Randomized and quasi-randomized controlled trials comparing a specified probiotic agent with a placebo or no probiotic in people with acute diarrhoea that is proven or presumed to be caused by an infectious agent. DATA COLLECTION AND ANALYSIS:Two reviewers independently assessed the methodological quality of the trial and extracted data. Primary outcomes were the mean duration of diarrhoea, stool frequency on day 2 after intervention and ongoing diarrhoea on day 4. A random-effects model was used.MAIN RESULTS: Sixty-three studies met the inclusion criteria with a total of 8014 participants. Of these, 56 trials recruited infants and young children. The trials varied in the definition used for acute diarrhoea and the end of the diarrhoeal illness, as well as in the risk of bias. The trials were undertaken in a wide range of different settings and also varied greatly in organisms tested, dosage, and participants' characteristics. No adverse events were attributed to the probiotic intervention. Probiotics reduced the duration of diarrhoea, although the size of the effect varied considerably between studies. The average of the effect was significant for mean duration of diarrhoea (mean difference 24.76 hours; 95% confidence interval 15.9 to 33.6 hours; n = 4555, trials = 35) diarrhoea lasting ≥ 4 days (risk ratio 0.41; 0.32 to 0.53; n = 2853, trials = 29) and stool frequency on day 2 (mean difference 0.80; 0.45 to 1.14; n = 2751, trials = 20). The differences in effect size between studies was not explained by study quality, probiotic strain, the number of different strains, the viability of the organisms, dosage of organisms, the causes of diarrhoea, or the severity of the diarrhoea, or whether the studies were done in developed or developing countries.AUTHORS' CONCLUSIONS: Used alongside rehydration therapy, probiotics appear to be safe and have clear beneficial effects in shortening the duration and reducing stool frequency in acute infectious diarrhoea. However, more research is needed to guide the use of particular probiotic regimens in specific patient groups.

Microbial ecology and host-microbiota interactions during early life stages

“…144 In addition, specific probiotic strains have been shown to exert a protective effect against acute diarrhea, rotavirus diarrhea, antibiotic-associated diarrhea (AAD). 44,[145][146][147] The beneficial effects maybe a combination of different mechanisms as balancing the commensal gut microbiota and modulating of immune response as well as physical exclusion of pathogens by probiotics…”

Diagnosis, management, and prevention of rotavirus gastroenteritis in children

“…[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] However, a recent systematic review of eight guidelines noted considerable variation in their quality, inconsistencies between the recommendations, lack of evidence for many recommendations, and lack of generalisability to general practice. 37 These were suggested as possible reasons why adherence to such guidelines is poor in high income countries.…”

Question 2 Probiotics in acute infectious diarrhoea: should we run with it?

“…In 2013, Szajewska et al 7 built on this existing evidence by publishing a meta-analysis investigating the potential benefit of a specific probiotic, Lactobacillus GG (LGG). The authors reviewed 11 RCTs comparing LGG use with placebo or no intervention.…”

“…The authors reviewed 11 RCTs comparing LGG use with placebo or no intervention. The authors acknowledge that the variable definition of acute infectious diarrhoea across included studies and the use of LGG in addition to ORS may have affected the results and, once again, significant heterogeneity (I 2 =98%) was identified which was felt to be ‘ caused by factors other than differences in methodological quality’7. Data were pooled for 2444 children, reporting a mean difference in duration of diarrhoea across all studies of −1.05 days (95% CI −1.7 to −0.4 days) favouring the LGG group, and −1.27 days (95% CI −2.04 to −0.49 days) when restricted to European studies.…”