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Review
. 2010 Nov 10;2010(11):CD003048.
doi: 10.1002/14651858.CD003048.pub3.

Probiotics for Treating Acute Infectious Diarrhoea

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Free PMC article
Review

Probiotics for Treating Acute Infectious Diarrhoea

Stephen J Allen et al. Cochrane Database Syst Rev. .
Free PMC article

Abstract

Background: Probiotics may offer a safe intervention in acute infectious diarrhoea to reduce the duration and severity of the illness.

Objectives: To assess the effects of probiotics in proven or presumed acute infectious diarrhoea.

Search strategy: We searched the Cochrane Infectious Diseases Group's trials register (July 2010), the Cochrane Controlled Trials Register (The Cochrane Library Issue 2, 2010), MEDLINE (1966 to July 2010), EMBASE (1988 to July 2010), and reference lists from studies and reviews. We also contacted organizations and individuals working in the field, and pharmaceutical companies manufacturing probiotic agents.

Selection criteria: Randomized and quasi-randomized controlled trials comparing a specified probiotic agent with a placebo or no probiotic in people with acute diarrhoea that is proven or presumed to be caused by an infectious agent.

Data collection and analysis: Two reviewers independently assessed the methodological quality of the trial and extracted data. Primary outcomes were the mean duration of diarrhoea, stool frequency on day 2 after intervention and ongoing diarrhoea on day 4. A random-effects model was used.

Main results: Sixty-three studies met the inclusion criteria with a total of 8014 participants. Of these, 56 trials recruited infants and young children. The trials varied in the definition used for acute diarrhoea and the end of the diarrhoeal illness, as well as in the risk of bias. The trials were undertaken in a wide range of different settings and also varied greatly in organisms tested, dosage, and participants' characteristics. No adverse events were attributed to the probiotic intervention.Probiotics reduced the duration of diarrhoea, although the size of the effect varied considerably between studies.The average of the effect was significant for mean duration of diarrhoea (mean difference 24.76 hours; 95% confidence interval 15.9 to 33.6 hours; n=4555, trials=35) diarrhoea lasting ≥4 days (risk ratio 0.41; 0.32 to 0.53; n=2853, trials=29) and stool frequency on day 2 (mean difference 0.80; 0.45 to 1.14; n=2751, trials=20).The differences in effect size between studies was not explained by study quality, probiotic strain, the number of different strains, the viability of the organisms, dosage of organisms, the causes of diarrhoea, or the severity of the diarrhoea, or whether the studies were done in developed or developing countries.

Authors' conclusions: Used alongside rehydration therapy, probiotics appear to be safe and have clear beneficial effects in shortening the duration and reducing stool frequency in acute infectious diarrhoea. However, more research is needed to guide the use of particular probiotic regimens in specific patient groups.

Conflict of interest statement

Stephen Allen is participating in ongoing research studies of lactobacilli and bifidobacteria provided by Cultech Ltd, UK, in the prevention of atopic disorders in infants and antibiotic‐associated diarrhoea in older people. In previous research, Scientific Hospital Supplies, UK, and Valio Ltd, Finland, have provided L. casei strain GG and also supported his attendance at a training workshop. Elizabeth Martinez is a Medical Manager for United Laboratories Inc., Philippines.

Figures

1
1
Funnel plot of comparison: 1 Primary diarrhoea outcomes, outcome: 1.1 Mean duration of diarrhoea.
2
2
Funnel plot of comparison: 1 Primary diarrhoea outcomes, outcome: 1.2 Diarrhoea lasting ≥ 4 days.
3
3
Funnel plot of comparison: 1 Primary diarrhoea outcomes, outcome: 1.3 Mean stool frequency on day 2.
1.1
1.1. Analysis
Comparison 1 Primary diarrhoea outcomes, Outcome 1 Mean duration of diarrhoea.
1.2
1.2. Analysis
Comparison 1 Primary diarrhoea outcomes, Outcome 2 Diarrhoea lasting ≥4 days.
1.3
1.3. Analysis
Comparison 1 Primary diarrhoea outcomes, Outcome 3 Mean stool frequency on day 2.
2.1
2.1. Analysis
Comparison 2 Secondary diarrhoea outcomes, Outcome 1 Diarrhoea lasting ≥3 days.
2.2
2.2. Analysis
Comparison 2 Secondary diarrhoea outcomes, Outcome 2 Mean stool frequency on day 3.
3.1
3.1. Analysis
Comparison 3 Strain of probiotic organisms, Outcome 1 Mean duration of diarrhoea.
3.2
3.2. Analysis
Comparison 3 Strain of probiotic organisms, Outcome 2 Diarrhoea lasting ≥4 days.
3.3
3.3. Analysis
Comparison 3 Strain of probiotic organisms, Outcome 3 Mean stool frequency on day 2.
4.1
4.1. Analysis
Comparison 4 Single organism versus combinations, Outcome 1 Mean duration of diarrhoea.
4.2
4.2. Analysis
Comparison 4 Single organism versus combinations, Outcome 2 Diarrhoea lasting ≥4 days.
4.3
4.3. Analysis
Comparison 4 Single organism versus combinations, Outcome 3 Mean stool frequency on day 2.
5.1
5.1. Analysis
Comparison 5 Live versus killed organisms, Outcome 1 Mean duration of diarrhoea.
6.1
6.1. Analysis
Comparison 6 Dose of probiotic; live organisms, Outcome 1 Mean duration of diarrhoea.
6.2
6.2. Analysis
Comparison 6 Dose of probiotic; live organisms, Outcome 2 Diarrhoea lasting ≥4 days.
6.3
6.3. Analysis
Comparison 6 Dose of probiotic; live organisms, Outcome 3 Mean stool frequency on day 2.
7.1
7.1. Analysis
Comparison 7 Children with rotavirus diarrhoea, Outcome 1 Mean duration of diarrhoea.
7.2
7.2. Analysis
Comparison 7 Children with rotavirus diarrhoea, Outcome 2 Mean stool frequency on day 2.
8.1
8.1. Analysis
Comparison 8 Severity of diarrhoea; studies of outpatients, Outcome 1 Mean duration of diarrhoea.
9.1
9.1. Analysis
Comparison 9 Mortality stratum for children and adults in the countries where trials were undertaken (children/adults), Outcome 1 Mean duration of diarrhoea.
9.2
9.2. Analysis
Comparison 9 Mortality stratum for children and adults in the countries where trials were undertaken (children/adults), Outcome 2 Diarrhoea lasting ≥4 days.
9.3
9.3. Analysis
Comparison 9 Mortality stratum for children and adults in the countries where trials were undertaken (children/adults), Outcome 3 Mean stool frequency on day 2.

Update of

  • Probiotics for treating infectious diarrhoea.
    Allen SJ, Okoko B, Martinez E, Gregorio G, Dans LF. Allen SJ, et al. Cochrane Database Syst Rev. 2004;(2):CD003048. doi: 10.1002/14651858.CD003048.pub2. Cochrane Database Syst Rev. 2004. PMID: 15106189 Updated. Review.

Comment in

  • Cochrane column.
    Young T, Bhutta ZA. Young T, et al. Int J Epidemiol. 2012 Apr;41(2):390-2. doi: 10.1093/ije/dys013. Epub 2012 Mar 19. Int J Epidemiol. 2012. PMID: 22434863 No abstract available.

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