Universal Recommendations for the Management of Acute Diarrhea in Nonmalnourished Children

Guarino, Alfredo; Vecchio, Andrea Lo; Dias, Jorge Amil; Berkley, James A.; Boey, Christopher Chiong Meng; Bruzzese, Dario; Cohen, Mitchell B.; Cruchet, Sylvia; Liguoro, Ilaria; Salazar–Lindo, Eduardo; Sandhu, Bhupinder; Sherman, Philip M.; Shimizu, Toshiaki

doi:10.1097/mpg.0000000000002053

Cited by 84 publications

(110 citation statements)

References 21 publications

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“…Nevertheless, as reflected by the low quality of evidence, the recommendation was that the evidence should be viewed with caution. Similar conclusions were reached by some other organisations or experts …”

Section: Introductionsupporting

confidence: 90%

Systematic review with meta‐analysis: Lactobacillus rhamnosus GG for treating acute gastroenteritis in children – a 2019 update

Szajewska

Kołodziej

Gieruszczak‐Białek

et al. 2019

Aliment Pharmacol Ther

100

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Background:Recently, evidence from a large randomised controlled trial (RCT) negated efficacy of Lactobacillus rhamnosus GG for treating acute gastroenteritis in children.Aim: To review RCTs in which L rhamnosus GG was used to treat acute gastroenteritis in children. Methods:The Cochrane Library, MEDLINE, and EMBASE databases were searched from May 2013 (end of last search) to January 2019. The primary outcomes were stool volume and duration of diarrhoea.Results: Eighteen RCTs (n = 4208) were included. Compared with placebo or no treatment, L rhamnosus GG use had no effect on stool volume but was associated with a reduced duration of diarrhoea (15 RCTs, n = 3820, mean difference, MD −0.85 day, 95% CI −1.15 to −0.56). L rhamnosus GG was effective when used at a daily dose of ≥10 10 CFU or <10 10 CFU; however, the latter produced results of borderline significance. L rhamnosus GG was more effective when used in European countries compared with non-European countries, particularly when considered by region.L rhamnosus GG use was associated with a reduced duration of hospitalisation. One RCT found that L rhamnosus GG had no effect on the total clinical severity score at 14 days after enrolment. Conclusions:Despite a recent large RCT demonstrating no effect of L rhamnosus GG, current evidence shows that, overall, L rhamnosus GG reduced both the duration of diarrhoea (with a higher impact in European countries) and hospitalisation in inpatients. These findings should be viewed in the context of the high heterogeneity and methodological limitations of the included trials. | 1377SZAJEWSKA Et Al.

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Section: Introductionsupporting

confidence: 90%

Systematic review with meta‐analysis: Lactobacillus rhamnosus GG for treating acute gastroenteritis in children – a 2019 update

Szajewska

Kołodziej

Gieruszczak‐Białek

et al. 2019

Aliment Pharmacol Ther

100

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“…Oral rehydration therapy is the mainstay of treatment for acute gastroenteritis and should be applied promptly. 1,2 However, despite proven efficacy, oral rehydration remains underused. Several guidelines recommend using probiotics with proven efficacy and safety for the management of children with acute gastroenteritis as an adjunct to rehydration therapy.…”

Section: Introductionmentioning

confidence: 99%

“…Several guidelines recommend using probiotics with proven efficacy and safety for the management of children with acute gastroenteritis as an adjunct to rehydration therapy. [1][2][3] Two strains most commonly recommended are Lactobacillus rhamnosus GG (L rhamnosus GG) 4,5 and Saccharomyces boulardii (S boulardii). 5 However, there is still controversy with regard to the efficacy of individual strains, even those included in the recommendations.…”

Section: Introductionmentioning

confidence: 99%

Systematic review with meta‐analysis: Saccharomyces boulardii for treating acute gastroenteritis in children—a 2020 update

Szajewska

Kołodziej

Zalewski

2020

Aliment Pharmacol Ther

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Summary Background There is still controversy with regard to the efficacy of individual probiotic strains for the management of acute gastroenteritis. Aim To update evidence on use of Saccharomyces boulardii for treating acute gastroenteritis in children. Methods The Cochrane Library, MEDLINE and EMBASE databases were searched from inception to December 2019 for randomised controlled trials (RCTs) that compared use of S boulardii with no S boulardii (defined as placebo or no treatment). The grey literature was searched through Google search. Authors of the original papers and S boulardii manufacturers were contacted for additional data. Results Twenty‐nine RCTs (among them, 20 newly identified trials) were included. Only 38% of trials adequately generated their randomisation sequence, only 17% adequately concealed allocation and only one trial adequately blinded participants, study personnel and outcome assessors. However, 83% provided complete outcome data. None of the trials evaluated the effect of S boulardii on stool volume. Compared with placebo or no treatment, S boulardii use reduced the duration of diarrhoea (23 RCTs, n = 3450, mean difference −1.06 day, 95% CI −1.32 to −0.79; high heterogeneity [I2 = 90%]) (very low quality of evidence). S boulardii use was also associated with a reduced duration of hospitalisation (8 RCTs, n = 999, mean difference −0.85 day, 95% CI −1.35 to −0.34; I2 = 91%) (very low quality of evidence). S boulardii reduced the risk of diarrhoea on day 2 to day 7 (low quality of evidence). Conclusions In children with acute gastroenteritis, low‐ to very low‐quality evidence suggests that S boulardii confers a benefit for several diarrhoeal outcomes.

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“…care protocols for children with acute diarrhea, using systematic reviews, Delphi methodology, and external peer review. They decided that oral rehydration and probiotics were the only treatments recommended for infants presenting with acute diarrhea [132]. At Cincinnati Children's, investigators placed in the electronic order set an entry for the administration of Lactobacillus rhamnosus GG.…”

Section: The Future Of Probioticsmentioning

confidence: 99%

Probiotics in Autoimmune and Inflammatory Disorders

Liu¹,

Alookaran²,

Rhoads³

2018

Preprint

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Probiotics have been used to ameliorate gastrointestinal symptoms since ancient times. Over the past 40 years, probiotics have been shown to exert major effects on the immune system, both in vivo and in vitro.  This interaction is clearly linked to gut microbes, their polysaccharide antigens, and key metabolites produced by these bacteria.  At least four metabolic pathways have been implicated in mechanistic studies of probiotics, based on carefully studied animal models.  Microbial-immune system crosstalk has been linked to short chain fatty acid production and signaling, tryptophan metabolism and the activation of aryl hydrocarbon receptors, nucleoside signaling in the gut, and activation of the intestinal histamine-2 receptor.  Several randomized controlled trials have now shown that microbial modification by probiotics may improve gastrointestinal symptoms and multi-organ inflammation in rheumatoid arthritis, ulcerative colitis, and multiple sclerosis.  Future work will need to carefully assess safety issues, selection of optimal strains and combinations, and attempts to prolong the duration of colonization of beneficial microbes.

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Universal Recommendations for the Management of Acute Diarrhea in Nonmalnourished Children

Abstract: Universal recommendations to assist health care practitioners in managing children with AGE may improve practitioners' compliance with guidelines, reduce inappropriate interventions, and significantly impact clinical outcome and health care-associated costs.

Cited by 84 publications

References 21 publications

Systematic review with meta‐analysis: Lactobacillus rhamnosus GG for treating acute gastroenteritis in children – a 2019 update

Systematic review with meta‐analysis: Lactobacillus rhamnosus GG for treating acute gastroenteritis in children – a 2019 update

Systematic review with meta‐analysis: Saccharomyces boulardii for treating acute gastroenteritis in children—a 2020 update

Probiotics in Autoimmune and Inflammatory Disorders

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