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Three Part Question

In [children with acute gastroenteritis] are [different probiotics preparations better than placebo] in [reducing the days of diarrhoea]?

Clinical Scenario

You are seeing a 6 month old girl in your office, with a history of non-bloody diarrhoea for the past 2 days. Your clinical diagnosis is an acute viral gastroenteritis and plan to give her probiotics. But you have at hand several presentations of different probiotics and wonder if they all are equally effective.

Search Strategy

MEDLINE (1966-Oct 2008).
Using PUBMED, Clinical Queries, broad sensitive search.
Search terms:
(("Probiotics"[Mesh] OR probiotic*) AND ("Diarrhea"[Mesh] OR "Gastroenteritis"[Mesh])) AND ((clinical[Title/Abstract] AND trial[Title/Abstract]) OR clinical trials[MeSH Terms] OR clinical trial[Publication Type] OR random*[Title/Abstract] OR random allocation[MeSH Terms] OR therapeutic use[MeSH Subheading])
Limit to human, English or Spanish, All Child: 0-18 years.

COCHRANE LIBRARY.
Search terms: "probiotic"

Search Outcome

1 Cochrane review was found. It did not compare different probiotic presentations.
213 papers were found in Medline, of which one is relevant to the clinical question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Canani et al 2007 Italy	571 children aged 3-36 months were randomised to: 1. Only oral rehydration (control) 2. Lactobacillus casei subsp rhamnosus GG 3. Saccharomyces boulardii 4. Bacillus clausii 5. Combination: L delbrueckii var bulgaricus, L acidophilus, Streptococcus thermophilus, B bifidum 6. Enterococcus faecium	RCT	Duration of diarrhoea (hours)	Shorter duration in the Lactobacillus casei [-32 hrs (95%IC -41 to -23)] and in the combination group [-37 hrs (95%IC -47 to -25)]. The other groups did not show a significantly shorter duration of diarrhoea compared to control.	Single blind. Investigators were blinded to the assigned treatment, patients were not.

Comment(s)

This is a well conducted trial comparing different probiotic presentations in the treatment of acute diarrhoea in children. Although it was not blinded, it is unlikely that patients (parents) had different expectations regarding treatments. Lactobacillus casei (subsp rhamnosus GG) and the combination of L delbrueckii var bulgaricus, L acidophilus, Strep thermophilus and B bifidum reduced the duration of the diarrhoea significantly.

Clinical Bottom Line

Not all probiotic presentations have the same efficacy in treating children with acute diarrhoea.

References

1. Roberto Berni Canani, Pia Cirillo, Gianluca Terrin, Luisa Cesarano, et al. Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations 2007; 335: 340