Cochrane Review: Probiotics NOT Proven Effective for Acute Gastroenteritis

Collinson S, Deans A, Padua-Zamora A, Gregorio GV, Li C, Dans LF, Allen SJ. Link to website with PDF availability: Probiotics for treating acute infectious diarrhoea. Cochrane Database of Systematic Reviews 2020, Issue 12. Art. No.: CD003048. DOI: 10.1002/14651858.CD003048.pub4. Thanks to Kipp Ellsworth for this reference.

This review identified “82 studies in 12,127 people (included 11,526 children) with acute diarrhea.” Key findings:

  • The number of children with diarrhea longer than 48 hours was not different between those taking a probiotic and those taking a placebo
  • “It was unclear whether taking probiotics shortened the time spent in hospital compared with taking a placebo or no additional treatment .”

My take: Probiotics probably make little or no difference in the setting of acute gastroenteritis/diarrhea. This analysis is based on large trials with low risk of bias.

Related blog posts:

Probiotics -Lack of Efficacy for Acute Gastroenteritis (Part 2)

This blog post highlights a second study showing a lack of efficacy of probiotics for acute gastroenteritis.  Link to 2 minute Summary: Quick Take on Probiotics for AGE

My take: While some probiotic strains have been shown to be helpful in some conditions (eg. antibiotic associated diarrhea), this study indicates that probiotics are likely ineffective in altering the course of acute gastroenteritis.

SB Freedman et al. N Engl J Med 2018; 379:2015-2026 Link to abstract: Multicenter Trial of a Combination Probiotic for Children with Gastroenteritis

Related blog posts:

Guidelines for Traveler’s Diarrhea in Adults

Full text: Guidelines on Traveler’s diarrhea in Adults from ACG

Some of the recommendations:

  • -use of oral rehydration if severe diarrhea (especially elderly).  “Most individuals with acute diarrhea…can keep up with fluids and salt by consumption of water, juices, sports drinks, soups, and saltine crackers
  • -against use of probiotics for acute diarrhea except in cases of post antibiotic-associated diarrhea
  • -for use of bismuth subsalicylates to slow stool passage
  • -for use of adjunctive loperamide in patients receiving antibiotics for traveler’s diarrhea (to increase chance for cure)
  • -for antibiotics in traveler’s diarrhea “where the likelihood of bacterial pathogens is high enough to justify the potential side effects of antibiotics”
  • -against antibiotics for community-acquired diarrhea

Table 4 outlines antibiotic selection.

Screen Shot 2016-04-12 at 7.52.47 PM

Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications/diets (along with potential adverse effects) should be confirmed by prescribing physician/nutritionist.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.