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Treating Diarrhea in Children: What About Probiotics?

Probiotics differ widely in their effectiveness.

Probiotics are live microorganisms (bacteria or yeast), found in yogurt and in supplements, which are touted to confer health benefits by promoting reestablishment of naturally occurring intestinal flora. Prior studies have shown that various probiotics can shorten the duration and reduce the severity of diarrhea. Researchers in Italy compared the efficacy of five probiotic preparations in a prospective, randomized, controlled trial that involved 571 consecutive children (age range, 3–36 months) who presented with diarrhea to their pediatricians. Patients received oral rehydration solution either alone (controls) or in addition to one of five different probiotic supplements for 5 days. Children with severe dehydration, malnutrition, or comorbid conditions were excluded.

The median duration of diarrhea was significantly shorter and the median number of daily stools was significantly lower 1 day after initiation of treatment in children who received Lactobacillus rhamnosus strain GG (78.5 hours; 4 stools) or a probiotic mix of four bacterial strains (70.0 hours; 4 stools) than in controls (115.0 hours; 5 stools). No differences occurred among groups in duration of vomiting or fever or in rates of hospital admission. No adverse side effects were reported.

Comment: Maintaining adequate hydration is the mainstay of treatment in otherwise healthy children with acute viral gastroenteritis. Probiotics might be reasonable to suggest, but their overall benefit is modest and is limited mostly to rotavirus infection. L. rhamnosus strain GG reduced the duration of diarrhea by almost 2 days in this study, is reasonably priced (less than US$1.00 daily), and appears to be safe. Not all probiotics are effective though, which is a key bit of information not provided by most health food stores.

— Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine September 7, 2007

Citation(s):

Canani RB et al. Probiotics for treatment of acute diarrhoea in children: Randomised clinical trial of five different preparations. BMJ 2007 Aug 18; 335:340.

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