Are probiotics effective in treating persistent diarrhea in children?
TYPE OF REVIEW
This is a Cochrane review and meta-analysis of four trials.
RELEVANCE FOR NURSING
Persistent diarrhea, defined as infectious diarrhea lasting 14 days or longer, can cause significant morbidity and mortality in children under five years of age, especially those in developing countries. Probiotics are live microorganisms (usually bacteria), similar to the beneficial microorganisms found in the human gut, and their use has produced encouraging results in several studies on treating acute infectious diarrhea. Nurses play an active role in providing probiotic interventions; therefore, it's important for nurses to know whether probiotics are effective in children with persistent diarrhea.
CHARACTERISTICS OF THE EVIDENCE
Four randomized controlled trials (with a total of 464 participants) met the inclusion criteria and were included in the review. All participants had to be 18 years of age or younger and have documented persistent diarrhea for at least 14 days. The intervention used in the trials was at least one probiotic compared with placebo or with no probiotic. The types of probiotics varied (and included Streptococcus thermophilus, Lactobacillus bulgaricus, Saccharomyces boulardii, Lactobacillus casei, Lactobacillus acidophilus sp, and Lactobacillus GG powder), as did the doses and frequency of dosing.
According to the authors of the review, the methodologic quality of the studies was generally poor. Only one trial had a low risk of bias; the risk of bias in two was unclear, and the remaining trial had a high risk of bias. The primary outcome was duration of diarrhea. The secondary outcomes were stool frequency, stool volume, weight-for-age. score, hospital stay, and death from any cause.
Only two studies reported the primary outcome; a combination of the results of these two trials (324 participants) showed that probiotics significantly reduced the duration of diarrhea by 4.02 days compared with placebo or with no probiotic. Two studies showed a significant decrease in stool frequency on day 5 with probiotics compared with placebo, and one of these studies also showed a reduction in length of hospital stay. Weight-for-age. score or death from any cause weren't reported in any of the studies. Three studies reported that no adverse events occurred and the remaining study didn't comment on adverse events.
BEST PRACTICE RECOMMENDATIONS
Although preliminary results are encouraging, there is insufficient evidence to recommend the use of probiotics in children with persistent diarrhea at this time. No solid conclusions could be reached because of the limited data available.
Future research should focus on methodologically well-designed and sufficiently powered trials to determine whether probiotics are beneficial as an adjunctive therapy in children with persistent diarrhea. Trials that use standardized definitions for persistent diarrhea and resolution of illness as well as specific probiotic strains and doses in well-defined participant subgroups should also be carried out.