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Lactobacillus Therapy Is Safe and May Be Effective in Children with Infectious Diarrhea

Question

  • Does lactobacillus therapy reduce the length of illness in children with infectious diarrhea?

Clinical Bottom Lines

  1. Lactobacillus is effective and safe in treating and preventing infectious diarrhea.1-2
  2. It is also effective and safe for antibiotic-associated diarrhea and diarrhea in children who are unusually susceptible (e.g., poor nutrition, impaired immune system, frequent exposure to pathogens).3


Summary of Key Evidence

  1. This metanalysis includes trials involving human subjects that involved lactobacillus treatment of infectious diarrhea in children and in which clinical outcomes were reported: randomized, blinded, controlled trials in which the treatment group received Lactobacillus (any species or strain) and the control group a placebo.
  2. 9 Studies met the inclusion criteria based on the basis of the examination of the methods section. 8 involved inpatients exclusively and 1 was a multi-center trial with a minority of outpatient subjects. None of the studies were done in the United States.
  3. Significant reduction in diarrhea duration of 0.7 days (95% CI:0.3-1.2days) in subjects given Lactobacillus compared with control subjects. Only 7 studies were included to estimate the effect of Lactobacillus on duration.
  4. The summary estimate for frequency for 3 studies was 1.6 fewer stools in treated subjects.
  5. Positive linear association exists between the log of the Lactobacillus dose and the reduction in diarrhea duration in days (p<0.01) in 8 of the included studies.

Additional Comments

  • Amount of stool was not reported in the studies, and therefore not accounted for.
  • The methods in the included studies differed as to how diarrhea was defined, how diarrhea intensity was measured, which strain of Lactobacillus was used and how lactobacillus was administered.
  • It included studies funded by pharmaceutical and food companies - may have biased toward submission and publication of only those studies that found therapy to be beneficial.
  • No significant adverse reactions were reported; myoclonic jerks were reported in 1 patient in the treatment group and 1 patient in the control group.
  • 48-hour course of Lactobacillus product is available for approximately $10.
  • All studies were done on inpatients; Lactobacillus-effects might be less pronounced in children who are not sick enough to require hospitalization; however most of the patients required only oral rehydration solution.

Citation

  1. Lactobacillus therapy for acute infectious diarrhea in children: a meta-analysis.
    Pediatrics 2002;109(4):678-84.
  2. Guandalini et al. Lactobacillus GC administrationin oral rehydration solution to children with acute diarrhea: a muticenter European trial. J Pediatr Gastroenterol Nutr 2000;30:629- 634.
  3. Shornikova et al. Lactobacillus reuteri is a therapeutic agent in aute diarrhea in young children. J Pediatr Gastroenterol Nutr 1997;24:399-404.

CAT Author: Lina Boujaoude, MD

CAT Appraisers: Jonathan Fliegel, MD

Date appraised: June 3, 2002

Last updated October 27, 2002
Department of Pediatrics and Communicable Diseases
© 1998-2002 University of Michigan Health System