University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

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