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

Question

• In children (ages 0-18) with acute diarrhea, does Lactobacillus help improve time to recovery?

Clinical Bottom Lines

1.  Lactobacillus GG (LGG) reduces the duration of acute diarrhea in children, especially of rotavirus etiology.
2. Lactobacillus did not have an effect on the volume or number of stools.
3. No significant adverse effects were associated with Lactobacillus GG administration.

Summary of Key Evidence

1. Meta-analysis of 8 randomized, controlled trials involving 988 participants ages 1 to 36 months.¹
   
2. Analysis showed a reduction in duration of diarrhea for those treated with LGG compared to placebo with a weighted mean difference of -1.1 days, 95% CI -1.9 to -0.3.
3. This reduction was especially true for diarrhea of rotavirus etiology: weighted mean difference -2.1 days, 95% CI -3.6 to -0.6.
4. There was no significant difference seen in stool output: weighted mean difference 8.9 mL/kg, 95% CI -86 to 104.

Additional Comments

• The studies were significantly heterogeneous.  In addition, many studies were not blinded.  There were variations in definition of termination of diarrhea.
• Lactobacillus appears most effective for diarrhea of rotavirus etiology.  However, now with the new rotavirus vaccine, the efficacy of lactobacillus may not be seen.
• No significant adverse effects appear to be associated with Lactobacillus administration.
• In a similar meta-analysis, similar effects were seen with a mean reduction in diarrhea duration of 0.7 days (95% confidence interval: 0.3-1.2 days).²
  
• Cost: for Lactobacillus GG, 30 capsules (10 billion live cells each) costs about $24-30.

Citation

1. Szajewska H, Skorka A. Ruszczynski M. Gieruszczak-Bialek D. Meta-analysis: Lactobacillus GG for treating acute diarrhoea in children. Alimentary Pharmacology & Therapeutics, 2007;25:871-81.
2. Van Niel CW, Feudtner C, Garrison MM, Christakis DA.  Lactobacillus therapy for acute infectious diarrhea in children: a meta-analysis. Pediatrics. 2002;109:678-84.

CAT Author: Karen Wiseman, MD

CAT Appraisers: Francis McBee-Orzulak, MD

Date appraised: September 26, 2007