, et al
Probiotics have clinical, microbiologic, and immunologic efficacy in acute infectious diarrhea
Pediatr Infect Dis J
; doi:

Researchers from Taiwan sought to determine whether probiotics decreased the severity of acute diarrhea in pediatric patients. Hospitalized children aged 3 months to 6 years with acute diarrhea, defined as three or more loose or liquid stools per day for less than 72 hours, were enrolled. Participants were randomized to receive either probiotics (Bio-Three [Bacillus mesentericus, Enterococcus faecalis, and Clostridium butyricum] 2.5 x 107 CFU/kg/d) or placebo, in three divided oral doses for seven days.

Between February 2006 and November 2007, 304 children with a mean age of approximately 29 months were enrolled. Data were analyzed on 293 participants who completed the study, including 150 in the probiotic group and 143 in the placebo group. A viral cause for the diarrhea was identified in 31% of study patients and a bacterial pathogen was found in 16%. Rotavirus, identified in 31% of all participants, was the most common etiologic agent identified.

Compared to those receiving placebo, subjects in the probiotic group had a shorter mean duration of diarrhea and hospital stay (60.1 hours vs 86.3 hours, P=.003; and 2.9 days vs 4.2 days, P=.009). Duration of diarrhea in those receiving probiotics was reduced significantly for diarrhea of viral origin, but not diarrhea caused by bacterial infection. However, the length of hospitalization was significantly shorter in those randomized to the probiotics group than in those receiving placebo regardless of etiologic agent.

The authors conclude that the probiotics used in this study attenuated the severity of acute diarrhea in hospitalized children and were associated with a reduced length of hospital stay.

While the introduction of rotavirus vaccine has reduced rotavirus hospitalizations by 85% and overall diarrheal hospitalizations by 40%, hospitalization of children with diarrheal illnesses remains a significant medical and economic burden in the US.1 Investigators conducting probiotics studies have focused on improving the treatment of diarrhea by either shortening its duration and/or preventing its complications, and nearly all studies show some positive effects.2 

Probiotics inhibit growth of harmful bacteria and normalize intestinal flora.3 The most recent Cochrane review concluded that probiotics appeared to be a moderately effective adjunctive therapy in reducing the duration of infectious diarrhea.4 In 2008 the European Societies for Gastroenterology and Pediatric Infectious Disease published the first evidence-based guidelines recommending probiotics as an effective adjunct in the management of diarrhea. This new guideline restricted its endorsement to “probiotic strains of proven efficacy and in appropriate doses.”5 

The current study demonstrated that probiotics reduced severity and length of hospital stay for children with acute infectious diarrhea, particularly when the diarrhea was not bacterial in origin. The probiotic strains assessed in the study now expand the roster of probiotics demonstrated to be efficacious in the...

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