Szajewska and colleagues from the Medical University of Warsaw, Poland, evaluated the efficacy of orally administered Lactobacillus GG (LGG) for preventing nosocomial diarrhea in 81 children, aged 1–36 months, hospitalized for reasons other than diarrhea. Exclusions included children who were breastfed or had known intestinal disease, visible blood in their stool, a history of vomiting or diarrhea within 3 days of admission, or use of probiotics within 7 days. In a randomized, double-blind, placebo-controlled study, 45 infants and toddlers in the treatment group received oral LGG (6 x 109 colony-forming units) while the 36 children in the control group received a comparable oral placebo twice daily for the duration of their hospital stay (min 2 days–max 23 days). Patients were evaluated daily for stool number and consistency, and during episodes of diarrhea, stools were obtained weekly for bacterial culture and rotavirus antigen analysis. Diarrhea, defined as 3 or more loose/watery stools per day, developed in 6.7% (3) of the children who received LGG compared with 33.3% (12) of the placebo group (P=.002). LGG was well tolerated. Four (95% CI, 2–10) patients would need to be treated with LGG to prevent a single episode of nosocomial diarrhea. In particular, LGG significantly reduced the risk of rotavirus gastroenteritis (RR .13; 95% CI, .02–.79), which was the most common infectious agent associated with nosocomial diarrhea. The effects of specific antibiotic therapy were not evaluated. The authors conclude that the prophylactic administration of LGG significantly reduced the risk of nosocomial diarrhea in young children, particularly with respect to rotavirus gastroenteritis.
Nosocomial diarrhea can prolong hospital stays, resulting in a significant increase in morbidity and cost.1 This study shows that LGG can reduce nosocomial diarrhea without adverse effects, and contributes to the accumulating evidence that probiotic substances like LGG can reduce the incidence, duration and severity of viral, antibiotic-associated and traveler’s diarrhea.2–,7 (Also see AAP Grand Rounds, March 2000.) The pathophysiology of probiotics’ therapeutic effect has not yet been defined. What is now needed are studies to elucidate the optimal dosage regimen of LGG and assess its cost-effectiveness in various settings. Alternative medical therapies are increasingly popular, although infrequently reported in the medical literature. This article reflects the resurgence of interest in and attempts at the objective study of one of these modalities.