Analysis of patient-level data from two multi-center randomized, placebo controlled, trials conducted in pediatric emergency departments in Canada and the U.S.. Participants were 3-48 months with >3 diarrheal episodes in the preceding 24 hours, and were symptomatic for <72 hours and <7 days in the Canadian and U.S. studies, respectively. Participants received either placebo or probiotic preparation (Canada-Lactobacillus rhamnosus R0011/L. helveticus R0052; U.S.-L. rhamnosus GG). The primary outcome was post-intervention moderate-to-severe disease.
The Results of the study are as follows:
- Pathogens were identified in specimens from 59.3% (928/1565) children.
- No pathogen groups were less likely to experience an MVS ≥9 based on treatment allocation.
- No differences between groups were identified for adenovirus, norovirus, rotavirus, or bacteria.
- At pathogen-group and among individual pathogens there were no differences in diarrhea duration or the total number of diarrheal stools between treatment groups, regardless of intervention allocation or among probiotic sub-groups. Among adenovirus-infected children, those administered the Lactobacillus rhamnosus R0011/L. helveticus R0052 product experienced fewer diarrheal episodes.
Thus, the researchers concluded that neither probiotic product resulted in less severe disease compared to placebo across a range of the most common etiologic pathogens. Clarifying the etiology of diarrhea among those without pathogens identified is warranted. According to the researchers, "the preponderance of the evidence does not support the notion that there are pathogen-specific benefits associated with probiotic use in children with [acute gastroenteritis]."
Reference:
Pathogen-Specific Effects of Probiotics in Children with Acute Gastroenteritis Seeking Emergency Care: A Randomized Trial by Stephen B Freedman et al. published in the Clinical Infectious Diseases
https://doi.org/10.1093/cid/ciab876
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