Bugs for bugs

Acute diarrhea is common, particularly among children. Treatment usually consists of replacing lost fluids and maintaining hydration, often with oral rehydration solutions. These solutions, however, do not reduce the severity or duration of diarrhea. Probiotics (microorganisms that have positive effects on health when colonizing the intestines) are being increasingly used to treat acute diarrhea, yet there are few randomized trials investigating the effectiveness of this treatment.

Researchers in Italy recently conducted a randomized trial comparing 5 different commercially available probiotic products along with oral rehydration solution in the treatment of acute diarrhea in 571 children between 3 months and 3 years of age. All the children in the study, who were otherwise healthy and had had diarrhea less than 48 hours, were given oral rehydration solution for 3 to 6 hours and were then fed with full-strength lactose-containing formula or cow’s milk, depending on age. The test group received probiotics prescribed for 5 days and administered orally. The control group did not.

The 5 probiotic products were as follows:

Lactobacillus rhamnosus strain GG;
Saccharomyces boulardii;
Bacillus clausii;
Enterococcus faecium SF68; and
a mix of Lactobacillus delbrueckii var bulgaricus, Streptococcus thermophilus, Lactobacillus acidophilus, and Bifidobacterium bifidum.

The study found that the median duration of diarrhea was significantly shorter (P < .001) among children who received the L rhamnosus strain (78.5 hours) or the mix of 4 bacterial strains (70.0 hours) compared with those who had oral rehydration solution alone (115.0 hours). One day after the first probiotic treatment, the daily number of stools was significantly lower (P < .001) in the L rhamnosus group and the mixed-strains group (4 per day) compared with those in the other groups (5 per day). Stool consistency, duration of vomiting, fever, and rate of admission to hospital were similar in all groups.

Bottom line

Probiotics can be effective in the treatment of acute diarrhea in children, but not all probiotics are equally effective.
Recommendations for the use of probiotics should be based on effectiveness data.

Footnotes

Source: Canani RB, Cirillo P, Terrin G, Cesarano L, Spagnuolo MI, De Vincenzo A, et al. Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations. BMJ 2007;335:340. DOI: 10.1136/bmj.39282.581736.55.