Two recent well-controlled studies (D Schnadower et al.N Engl J Med 2018; 379:2002-2014, SB Freedman et al. N Engl J Med 2018; 379:2015-2026) showed that probiotic-treated children with acute gastroenteritis (AGE) did not have better outcomes than placebo-treated children. In addition, a recent AGA practice guideline recommended against the use of probiotics for most GI conditions, including in AGE.
However, a new report (H Szajewska et al. JPGN 2020; 71; 261-69) from an ESPGHAN working group recommends that probiotics should have a role for AGE. Several points about this report:
- Their recommendations are very qualified: “weak recommendation” with “low to very low certainty of evidence” for the following in descending order: S boulardiii, L rhamnosis GG, L reuteri DSM 17938, and L rhamnosus 19070 & L reuteri DSM 12246
- It is noted that this report has a disclaimer from ESPGHAN: “it does not represent ESPGHAN policy and is not endorsed by ESPGHAN”
- The authors have extensive disclosures
- The report notes that “despite large number of identified trials, we could not identify 2 randomized controlled trials of high quality for any strain that provided benefit when used for treating acute gastroenteritis”
Of note, the associated editorial (pg 146-47) also favors probiotics in the setting of AGE. “These recommendations…have clarified that there is a role for probiotics in treating” AGE.
Related article (just published): F Mourney et al. The Pediatric Infectious Disease Journal: August 7, 2020 – Volume Online First – Issue –doi: 10.1097/INF.0000000000002849 A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial of Saccharomyces boulardii in Infants and Children With Acute Diarrhea (n=100) Key findings: The time of recovery from diarrhea was significantly shorter in the probiotic group compared with the placebo group (65.8 ± 12 hours vs. 95.3 ± 17.6 hours, P = 0.0001).
My take: Overall, probiotic effectiveness is overstated; though, some strains may be helpful for AGE. Still, there are concerns about variation in production and quality standards even in these strains.
Related blog posts:
- AGA Practice Guidelines: Probiotics do NOT help most GI conditions
- Lack of Efficacy for Probiotics in AGE (Part 1)
- Lack of Efficacy for Probiotics in AGE (Part 2)