Probiotics in the treatment and prevention of acute infectious diarrhea ininfants and children: A systematic review of published randomized, double-blind, placebo-controlled trials

Background: This review was designed to assess the evidence from randomized controlled trials on effects of probiotics in the treatment and prevention of acute infectious diarrhea in infants and children. Methods: A systematic review of published, randomized, double-blind, placeb o-controlled trials on probiotics in the treatment or prevention of acute d iarrhea defined as >3 loose or watery stools per 24 hours in infants and ch ildren. Results: The use of probiotics as compared with placebo was associated with a significantly reduced risk of diarrhea lasting >3 days. The pooled estim ate risk was 0.43 (95% CL 0.34-0.53) with a fixed-effect model, and remaine d significant in a random-effect model (0.40; 95% CL 0.28-0.57). Only Lacto bacillus GG showed a consistent effect. Probiotics significantly reduced th e duration of diarrhea when compared with placebo, particularly in rotavira l gastroenteritis-the pooled, weighted, mean difference (WMD) assuming the random-effect model was -20.1 hours (95% CI, -26.1 to -14.2) and -24.8 (95% CL -31.8 to -17.9) respectively. A meta-analysis of the prevention studies was not feasible because of significant clinical and statistical heterogen eity. Conclusions: There is evidence of a clinically significant benefit of probi otics in the treatment of acute infectious diarrhea in infants and children , particularly in rotaviral gastroenteritis. Lactobacillus GG showed the mo st consistent effect., although other probiotic strains may also be effecti ve. Further research is needed. Clinical and statistical heterogeneity of t he prophylactic interventions preclude drawing firm conclusions about the e fficacy of probiotics in preventing acute gastroenteritis.