Skip to main content

Efficacy of Probiotic Use in Acute Diarrhea in Children: A Meta-Analysis

Digestive Diseases and Sciences volume 47, pages 2625–2634 (2002)Cite this article

Abstract

Our objective was to determine the efficacy of probiotic use in reducing the duration of increased stool output in children with acute diarrheal illness. Eligible studies were limited to trials of probiotic therapy in otherwise healthy children <5 years old with acute-onset diarrhea. The main outcome variable was difference in diarrhea duration between treatment and control groups. Our meta-analysis of 18 eligible studies suggests that coadministration of probiotics with standard rehydration therapy reduces the duration of acute diarrhea by ∼1 day [random-effects pooled estimate = −0.8 days (−1.1, −0.6), P < 0.001]. Differences in treatment effect between studies was assessed by calculating the Q statistic (Q = 204.1, P < 0.001). In subsequent analyses limited to studies of hospitalized children, to double-blinded trials, and to studies evaluating lactobacilli, the pooled estimates were similar (−0.6 to −1.2 days, P < 0.001). In conclusion, bacterial probiotic therapy shortens the duration of acute diarrheal illness in children by approximately one day.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

REFERENCES

  1. Glass RI, Lew JF, Gangarosa RE, et al: Estimates of morbidity and mortality rates for diarrheal diseases in American children. J Pediatr 118:S27–S33, 1991

    Google Scholar 

  2. Guerrant RL, Hughes JM, Lima NL, Crane J: Diarrhea in developed and developing countries: magnitude, special settings, and etiologies. Rev Infect Dis. 12(suppl 1): S41–S50, 1990

    Google Scholar 

  3. Zimmerman CM, Bresee JS, Parashar UD, et al: Cost of diarrhea-associated hospitalizations and outpatient visits in an insured population of young children in the United States. Pediatr Infect Dis J. 20:14–19, 2001

    Google Scholar 

  4. Jack RW, Tagg JR, Ray B: Bacteriocins of gram-positive bacteria. Microbiol Rev 59:171–200, 1995

    Google Scholar 

  5. Neeser JR, Granato D, Rouvet M, et al: Lactobacillus johnsonii La1 shares carbohydrate-binding specificities with several enteropathogenic bacteria. Glycobiology 10(11):1193–9, 2000

    Google Scholar 

  6. Duffy LC, Zielezny MA, Riepenhoff-Talty M, et al: Reduction of virus shedding by B. bifidum in experimentally induced MRV infection. Dig Dis Sci 39:2334–40, 1994

    Google Scholar 

  7. Duffy LC, Zielezny MA, Riepenhoff-Talty M, et al: Effectiveness of Bifidobacterium bifidum in mediating the clinical course of murine rotavirus diarrhea. Pediatr Res 35(6):690–5, 1994

    Google Scholar 

  8. Ohya T, Marubashi T, Ito H: Significance of fecal volatile fatty acids in shedding of Escherichia coli 0157 from calves: experimental infection and preliminary use of a probiotic product. J Vet Med Sci. 62(11):1151–5, 2000

    Google Scholar 

  9. Pelto L, Isolauri E, Lilius EM, Nuutila J, Salminen S: Probiotic bacteria down-regulate the milk-induced inflammatory response in milk-hypersensitive subjects but have an immunostimulatory effect in healthy subjects. Clin Exp Allergy 28:1474–9, 1998

    Google Scholar 

  10. Majamaa H, Isolauri E: Probiotics: a novel approach in the management of food allergy. J Allergy Clin Immunol 99:179–85, 1997

    Google Scholar 

  11. Sakamoto I, Igarashi M, Kimura K, et al: Suppressive effect of Lactobacillus gasseri OLL 2716 (LG21) on Helicobacter pylori infection in humans. J Antimicrob Chemother 47:709–10, 2001

    Google Scholar 

  12. Goldin BR, Gorbach SL, Saxelin M, et al: Survival of Lactobacillus species (strain GG) in human gastrointestinal tract. Dig Dis Sci 37:121–8, 1992

    Google Scholar 

  13. Salminen S, Donahue D: Safety assessment of Lactobacillus strain GG. Nutr Today Suppl 31:12S–15S, 1996

    Google Scholar 

  14. Shu Q, Qu F, Gill HS: Probiotic treatment using Bifidobacterium lactis HN019 reduces weanling diarrhea associated with rotavirus and Escherichia coli infection in a piglet model. J Pediatr Gastroenterol Nutr 33:171–7, 2001

    Google Scholar 

  15. Barone C, Pettinato R, Avola E, et al: Comparison of three probiotics in the treatment of acute diarrhea in mentally retarded children. Minerva Pediatr 52(3):161–5, 2000

    Google Scholar 

  16. Bin LX: Controlled clinical trial in infants and children comparing Lacteol Fort sachets with two antidiarrhoeal reference drugs. Ann Pediatr 42:396–401, 1995

    Google Scholar 

  17. Chapoy P: Treatment of acute diarrhea in infants: a controlled trial of Saccharomyces boulardii. Ann Pediatr 32:561–3, 1985

    Google Scholar 

  18. Rautanen T, Isolauri I, Salo E, Vesikari T: Management of acute diarrhea with low osmolarity oral rehydration solutions and Lactobacillus strain GG. Arch Dis Child 79:157–160, 1998

    Google Scholar 

  19. Raza S, Graham M, Allen SJ, Sultana, Cuevas L, Hart CA: Lactobacillus GG promotes recovery from acute diarrhea in Pakistan. Pediatr Infect Dis J 14:107–111, 1995

    Google Scholar 

  20. Kaila M, Isolauri E, Saxelin M, Arvilommi H, Vesikari T: Viable vs inactivated lactobacillus strain GG in acute rotavirus diarrhea. Arch Dis Child 72:51–53, 1995

    Google Scholar 

  21. Pensabene I, Mancuso M, Contaldo A, et al: A multicenter European trial on the use of Lactobacillus GG in children with acute-onset diarrhea. Ital J Gastroenterol Hepatol 30(suppl 1):A25, Abstract 6, 1998

    Google Scholar 

  22. Michielutti F, Bertini M, Presciuttini B, Andreotti G: Clinical assessment of a new oral bacterial treatment for children with acute diarrhea. Minerva Med 87(11):545–50, 1996

    Google Scholar 

  23. Simakachorn N, Pichaipat V, Ritipornpaisarn P, et al: Clinical evaluation of the addition of lyophilized, heat-killed L. acidophilus LB to oral rehydration therapy in the treatment of acute diarrhea in children. World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. Boston, Massachusetts, August 2000, Abstract 993

  24. Costa-Ribeiro H, Ribeiro TCM, Mattos AP, et al: Use of Lactobacillus GG in the treatment of severe, acute diarrhea in adverse environmental conditions. World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. Boston, Massachusetts, August 2000, Abstract 985

  25. Cetina-Sauri G, Sierra Basto G: Evaluation of Saccharomyces boulardii for the treatment of acute diarrhea in pediatric patients. Ann Pediatr 41:397–400, 1994

    Google Scholar 

  26. Lee MC, Lin LH, Hung KL, Wu HY: Oral bacterial therapy promotes recovery from acute diarrhea in children. Acta Paediatr Tw 42:301–5, 2001

    Google Scholar 

  27. Guandalini S, Pensabene L, Zikri MA, et al: Lactobacillus GG administered in oral rehydration solution to children with acute diarrhea: a multicenter European trial. J Pediatr Gastroenterol Nutr 30(1):54–60, 2000

    Google Scholar 

  28. Rosenfeldt V, Michaelsen KF, Moller PL, et al: Effect of new lactobacillus strains in acute diarrhea among children attending day care centers. ESPGHAN 34th annual meeting. Geneva, Switzerland, May 2001, Abstract 102

  29. Rosenfeldt V, Tvede M, Michaelsen KF, et al: Effect of new probiotic Lactobacillus strains in young children hospitalized with acute diarrhea. ESPGHAN 34th annual meeting. Geneva, Switzerland, May 2001, Abstract 103

  30. Ahmad RA, Lukito W. Firmansyah A, et al: Effect of a combined probiotic, prebiotics and micronutrients supplementation in reducing duration of acute infantile diarrhea. World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. Boston, Massachusetts, August 2000, Abstract 984

  31. Berni Canani R, Albano F, Cosarano L, et al: Probiotics for acute diarrhea: a comparative study. ESPGHAN 34th annual meeting. Geneva, Switzerland, May 2001, Abstract 7

  32. Guarino A, Canani RB, Spagnuolo MI, Albano F, Di Benedetto L: Oral bacterial therapy reduces the duration of symptoms and of viral excretion in children with mild diarrhea. J Pediatr Gastroenterol Nutr 25(5):516–9, 1997

    Google Scholar 

  33. Isolauri E, Juntunen M, Rautanen T, Sillanaukee P, Koivula T: A human Lactobacillus strain (Lactobacillus GG) promotes recovery from acute diarrhea in children. Pediatrics 88:90–97, 1991

    Google Scholar 

  34. Isolauri E, Kaila M, Mykkanen H, Ling W, Salminen S: Oral bacteriotherapy for viral gastroenteritis. Dig Dis Sci 39:2595–2600, 1994

    Google Scholar 

  35. Kaila M, Isolauri E, Soppi E, et al: Enhancement of the circulating antibody secreting cell response in human diarrhea by a human Lactobacillus strain. Pediatr Res 32(2):141–4, 1992

    Google Scholar 

  36. Majamaa H, Isolauri E, Saxelin M, Vesikari T: Lactic acid bacteria in the therapy of acute gastroenteritis. J Pediatr Gastroenterol Nutr 20:333–338, 1995

    Google Scholar 

  37. Pant AR, Graham M, Allen SJ, Harikul S, Sabchareon A, Cuevas L, Hart CA: Lactobacillus GG and acute diarrhea in young children in the tropics. J Trop Pediatr 42:162–165, 1996

    Google Scholar 

  38. Pearce JL, Hamilton JR: Controlled trial of orally administered lactobacilli in children. J Pediatr 84:261–262, 1974

    Google Scholar 

  39. Shornikova A, Casas I, Isolauri E, Mykkanen H, Vesikari T: Lactobacillus reuteri as a therapeutic agent in acute diarrhea in young children. J Pediatr Gastroenterol Nutr 24:399–404, 1997

    Google Scholar 

  40. Shornikova A, Casas I, Mykkanen H, Salo E, Vesikari T: Bacteriotherapy with lactobacillus reuteri in rotavirus gastroenteritis. Pediatr Infect Dis J 16:1103–1107, 1997

    Google Scholar 

  41. Shornikova AV, Isolauri E, Burkanova L, Lukovnikova S, Vesikari T: A trial in the Karelian republic of oral rehydration and Lactobacillus GG for treatment of acute diarrhea. Acta Paediatr Scand 86:460–5, 1997

    Google Scholar 

  42. Simakachorn N, Pichaipat V, Rithipornpaisarn P, Congkaew C, Tongpradi P, Varavithya W: Clinical evaluation of the addition of lyophilized, heat-killed Lactobacillus acidophilus LB to oral rehydration therapy in the treatment of acute diarrhea in children. J Pediatr Gastroenterol Nutr 30:68–72, 2000

    Google Scholar 

  43. Boulloche J, Mouterde O, Mallet E: Management of acute diarrhea in infants and toddlers: controlled study of the antidiarrheal efficacy of killed Lactobacillus acidophilus (LB strain) versus a placebo and a reference agent (loperamide). Ann Pediatr 41:457–63, 1994

    Google Scholar 

  44. Begg CB, Mazumdar M: Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–1101, 1994

    Google Scholar 

  45. Egger M, Davey Smith G, Schneider M, Minder C: Bias in meta-analysis detected by a simple, graphical test. BMJ 315:629–34, 1997

    Google Scholar 

  46. DerSimonian R, Laird N: Meta-analysis in clinical trials. Cont Clin Trials 7:177–188, 1986

    Google Scholar 

  47. Szajewska H, Mrukowicz JZ: Probiotics in the treatment and prevention of acute infectious diarrhea in infants and children: a systematic review of published randomized, double-blind, placebo-controlled trials. J Pediatr Gastroenterol Nutr 33:S17–S25, 2001

    Google Scholar 

  48. van Niel CW, Feudtner C, Garrison MM, Christakis DA: Lactobacillus therapy for acute infectious diarrhea in children: a meta-analysis. Pediatrics 109:678–84, 2002

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Children's Hospital, Boston, Massachusetts, USA

    Jeannie S. Huang, Athos Bousvaros & Emily J. Davidson

  2. Harvard School of Public Health, Boston, Massachusetts, USA

    Jeannie S. Huang, Athos Bousvaros, John W. Lee, Angela Diaz & Emily J. Davidson

  3. Mount Sinai School of Medicine, New York, New York, USA

    Angela Diaz

Authors
  1. Jeannie S. Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Athos Bousvaros
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John W. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Angela Diaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emily J. Davidson
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Huang, J.S., Bousvaros, A., Lee, J.W. et al. Efficacy of Probiotic Use in Acute Diarrhea in Children: A Meta-Analysis. Dig Dis Sci 47, 2625–2634 (2002). https://doi.org/10.1023/A:1020501202369

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1020501202369

  • probiotics
  • diarrhea
  • children
  • meta-analysis