Microbiome Resource Center

Microbiome Resource Center

Disclosures: The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD071915) and by the Canadian Institutes of Health Research (grants 286384 and 325412). The Pediatric Emergency Care Applied Research Network was supported by the Health Resources and Services Administration, Maternal and Child Health Bureau, Emergency Medical Services for Children Program through the following cooperative agreements: U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC00008, U03MC22684, and U03MC22685. Please see the study for all other authors’ relevant financial disclosures.
August 06, 2021
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Probiotics not beneficial for children with gastroenteritis despite diarrhea severity

Disclosures: The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD071915) and by the Canadian Institutes of Health Research (grants 286384 and 325412). The Pediatric Emergency Care Applied Research Network was supported by the Health Resources and Services Administration, Maternal and Child Health Bureau, Emergency Medical Services for Children Program through the following cooperative agreements: U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC00008, U03MC22684, and U03MC22685. Please see the study for all other authors’ relevant financial disclosures.
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In children with acute gastroenteritis, probiotics did not offer benefits, regardless of diarrhea timing or severity, according to a study published in the American Journal of Gastroenterology.

“[It] has been proposed that the timing of probiotic initiation in the course of illness and a prolonged interval from symptom onset to the initiation of probiotics may explain the identified lack of benefit,” David Schnadower, MD, MPH, from the division of emergency medicine, Cincinnati Children’s Hospital Medical Center, department of pediatrics, University of Cincinnati College of Medicine in Ohio, and colleagues wrote. “Questions have also been raised about the role of severity of illness (ie, diarrhea frequency) on the lack of probiotic treatment effect. Addressing the association between [acute gastroenteritis] characteristics and probiotic therapy efficacy is crucial to assess the generalizability of the findings from recent [randomized controlled trials (RCTs)]. Therefore, we conducted a secondary, a priori planned analysis using combined patient-level data from the two large RCTs to determine whether probiotic efficacy varies based on duration of symptoms and frequency of diarrhea at the time of treatment initiation.”

In children with acute gastroenteritis, probiotics did not provide benefits, regardless of diarrhea timing or severity. Source: Adobe Stock

Schnadower and colleagues identified 1,770 kids aged 3 to 48 months, of whom 882 received a probiotic. The two probiotics assessed included Lactobacillus rhamnosus GG and a combination probiotic: L. rhamnosus and Lactobacillus helveticus. Investigators stratified patients into severity groups based on duration (less than 24, 24 to less than 72, and 72 hours or more) and the frequency of diarrhea episodes in the 24 hours (3 or less, 4 to 5, and 6 or more) before presentation.

Regression models were used to evaluate the relationship between pretreatment diarrhea and treatment arm (probiotic or placebo) in the presence of moderate-to-severe gastroenteritis. Other outcomes include diarrhea frequency and duration, unscheduled health care provider visits and hospitalization.

“There was no evidence of interaction between baseline severity and treatment (P = .61) for the primary or any of the secondary outcomes: diarrhea duration (P = .88), maximum diarrheal episodes in a 24-hour period (P = .87), unscheduled health care visits (P = .21), and hospitalization (P = .87),” the authors wrote.

Results showed groups were no different with regard to development of moderate-to-severe gastroenteritis symptoms after the start of treatment (probiotic — 18.4% [162/882] vs. placebo — 18.3% [162/888]; RR 1; 95% CI, 0.87, 1.16).

“These results clarify that diarrhea duration and frequency before initiating probiotic therapy are not associated with the presence or absence of beneficial effects in the study population,” Schnadower and colleagues wrote.