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

Probiotics for treating acute infectious diarrhoea

Stephen J Allen  1 , Elizabeth G Martinez, Germana V Gregorio, Leonila F Dans
Affiliations
Review

Probiotics for treating acute infectious diarrhoea

Stephen J Allen et al. Cochrane Database Syst Rev. .

Update in

  • Probiotics for treating acute infectious diarrhoea.
    Collinson S, Deans A, Padua-Zamora A, Gregorio GV, Li C, Dans LF, Allen SJ. Collinson S, et al. Cochrane Database Syst Rev. 2020 Dec 8;12(12):CD003048. doi: 10.1002/14651858.CD003048.pub4. Cochrane Database Syst Rev. 2020. PMID: 33295643 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.

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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.
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Update of

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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References

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Bellomo 1982 {published data only}
    1. Bellomo G, Finocchiaro C, Frigerio G, Mangiagli A, Nicastro L. Controlled study ofEnterococcus LAB strain SF68 in acute enteritis in children with concomitant respiratory infection [Studio controllato sull'enterococco L.A.B. ceppo SF 68 nelle enteriti acute del bambino concomitanti ad infezioni delle vie respiratorie]. Clinica Pediatrica 1982;64:219‐27.
Bin Li Xie 1995 {published data only}
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Brewster 2004 {published data only}
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Camarri 1981 {published data only}
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Cetina Sauri 1990 {published data only}
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Chandra 2002 {published data only}
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Chicoine 1973 {published data only}
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Costa‐Ribeiro 2000a {published data only}
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Costa‐Ribeiro 2000b {published data only}
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de dios Pozo‐O 1978 {published data only}
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Gracheva 1996 {published data only}
    1. Gracheva NM, Gavrilov AF, Solov'eva AI, Smirnov VV, Sorokulova IB, Reznik SR, et al. The efficacy of the new bacterial preparation biosporin in treating acute intestinal infections. Zhurnal Mikrobiologii, Epidemiologii, i Immunobiologii 1996;1(1):75‐7. - PubMed
Henker 2007b {published data only}
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Heydarian 2010 {published data only}
    1. Heydarian F, Kianifar HR, Ahanchian H, Khakshure A, Seyedi J, Moshirian D. A comparison between traditional yogurt and probiotic yogurt in non‐inflammatory acute gastroenteritis. Saudi Med J 2010;31(3):280‐3. - PubMed
Isolauri 1991 {published data only}
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Kaila 1992 {published data only}
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Kaila 1995 {published data only}
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Korviakova 2000 {published data only}
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Le Leyur 2010 {published data only}
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Lei 2006 {published data only}
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Lin 2009 {published data only}
    1. Lin JS, Chiu YH, Lin NT, Chu CH, Huang KC, Liao KW, et al. Different effects of probiotic species/strains on infections in preschool children: a double‐blind, randomized, controlled study. Vaccine 2009;27(7):1073‐9. - PubMed
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Majamaa 1995 {published data only}
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Mazo 2006 {published data only}
    1. Mazo SA, Arias SA. Efficacy and safety of milk fermented by lactobacillus (kumis) in nutritional recovery of undernourished children and control of their diarrhoea episodes. Revista Facultad Nacional de Salud Pública 2006;24(2):83‐97.
Michielutti 1995 {published data only}
    1. Michielutti F, Bertini M, Presciuttini B, Andreotti G. Clinical assessment of a new oral bacterial treatment for children with acute diarrhea [Valutazione clinica di un nuovo batterioterapico orale in pazienti di eta pediatrica con diarrea acuta]. Minerva Medica 1996;87(11):545‐50. - PubMed
Mitra 1990 {published data only}
    1. Mitra AK, Rabbini GH. A double‐blind, controlled trial of bioflorin (Streptococcus faecium SF68) in adults with acute diarrhea due to Vibrio chlolerae and entertoxigenic Escherichia coli. Gastroenterology 1990;99(4):1149‐52. - PubMed
Moraes 2001 {published data only}
    1. Moraes E, Chinzon D, Coelho LG, Fernandes TF, Haddad MT, et al. A multicentric, randomised, investigator‐blind, parallel group study to assess the efficacy, safety and tolerability of Racecadotril versus Saccharomyces boulardii in the treatment of acute diarrhoea in adults [Estudo multicêntrico de grupos paralelos, randomizado, cego para o investigador, para avaliar a eficácia, segurança e tolerabilidade do racecadotril versus Saccharomyces boulardii no tratamento da diarréia aguda em adultos]. Revista Brasileira de Medicina 2001;58(1‐2):65‐74.
Niv 1963 {published data only}
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Pedone 1999 {published data only}
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Rafeey 2008b {published data only}
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Rautanen 1998 {published data only}
    1. Rautanen T, Isolauri E, Salo E, Vesikari T. Management of acute diarrhoea with low osmolarity oral rehydration solutions and Lactobacillus strain GG. Archives of Disease in Childhood 1998;79(2):157‐60. - PMC - PubMed
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Salazar‐Lindo 2004 {published data only}
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Savas‐Erdeve 2009 {published data only}
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Schrezenmeir 2004 {published data only}
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References to ongoing studies

Freedman 2010 {published data only}
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