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. 2013;13 Suppl 3(Suppl 3):S16.
doi: 10.1186/1471-2458-13-S3-S16. Epub 2013 Sep 17.

Systematic review of probiotics for the treatment of community-acquired acute diarrhea in children

Jennifer A Applegate, Christa L Fischer Walker, Ramya Ambikapathi, Robert E Black

Systematic review of probiotics for the treatment of community-acquired acute diarrhea in children

Jennifer A Applegate et al. BMC Public Health. 2013.

Abstract

Background: Oral rehydration salts (ORS), zinc, and continued feeding are the recommended treatments for community-acquired acute diarrhea among young children. However, probiotics are becoming increasingly popular treatments for diarrhea in some countries. We sought to estimate the effect of probiotics on diarrhea morbidity and mortality in children < 5 years of age.

Methods: We conducted a systematic review of randomized controlled trials to estimate the effect of probiotic microorganisms for the treatment of community-acquired acute diarrhea in children. Data were abstracted into a standardized table and study quality was assessed using the Child Health Epidemiology Reference Group (CHERG) adaption of the GRADE technique. We measured the relative effect of probiotic treatment in addition to recommended rehydration on hospitalizations, duration and severity. We then calculated the average percent difference for all continuous outcomes and performed a meta-analysis for discrete outcomes.

Results: We identified 8 studies for inclusion in the final database. No studies reported diarrhea mortality and overall the evidence was low to moderate quality. Probiotics reduced diarrhea duration by 14.0% (95% CI: 3.8-24.2%) and stool frequency on the second day of treatment by 13.1% (95% CI: 0.8 - 25.3%). There was no effect on the risk of diarrhea hospitalizations.

Conclusion: Probiotics may be efficacious in reducing diarrhea duration and stool frequency during a diarrhea episode. However, only few studies have been conducted in low-income countries and none used zinc (the current recommendation) thus additional research is needed to understand the effect of probiotics as adjunct therapy for diarrhea among children in developing countries.

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Figures

Figure 1
Figure 1
Results of literature search for studies on treatment of diarrhea with probiotics
Figure 2
Figure 2
Forest plot for the effect of probiotics as compared to control on diarrhea hospitalizations Legend: * L. bulgaricus, L. acidophilus, Streptococcus thermophilus, B. bifidum ** LGG, L. acidophilus, L. casei, L. plantarum, B. infantis
Figure 3
Figure 3
Application of standardized rules for choice of final outcome to estimate effect of probiotics on the reduction of diarrhea mortality
See this image and copyright information in PMC

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