ABSTRACT: The use of probiotics has been suggested in the treatment of acute gastroenteritis (AGE) in addition to early rehydration and avoidance of dietary restrictions. This document provides recommendations for the use of probiotics for the treatment of AGE in previously healthy infants and children based on a systematic review of previously completed systematic reviews and of randomized controlled trials (RCTs) published subsequently to these reviews. The recommendations were formulated only if at least 2 RCTs that used a given probiotic (with strain specification) were available. The GRADE system developed by the Grading of Recommendations, Assessment, Development, and Evaluations Working Group, was used to grade the strength of evidence and grades of recommendations used in these guidelines. It offers 4 categories of the quality of the evidence (high, moderate, low, and very low) and 2 categories of the strength of recommendation (strong or weak). The use of the following probiotics (in alphabetical order) may be considered in the management of children with AGE in addition to rehydration therapy: Lactobacillus rhamnosus GG (low quality of evidence, strong recommendation) and Saccharomyces boulardii (low quality of evidence, strong recommendation). Less compelling evidence is available for Lactobacillus reuteri DSM 17938 (very low quality of evidence, weak recommendation) and heat-inactivated Lactobacillus acidophilus LB (very low quality of evidence, weak recommendation). The latter, although traditionally discussed with other probiotics, does not fit with the definition of probiotics. Other strains or combinations of strains have been tested, but evidence of their efficacy is weak or preliminary.
*Medical University of Warsaw, Department of Paediatrics, Warsaw, Poland
†Department of Translational Medicine, Section of Pediatrics, University of Naples Federico II, Naples, Italy
‡Department of Paediatrics, Children's Hospital Zagreb, University of Zagreb School um of Medicine, Zagreb, Croatia
§Department of Pediatrics, University Hospital Policlinico, University of Bari, Italy
||Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel-Aviv University, Israel
¶Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
#Pediatric Gastroenterology and Nutrition Unit, Soroka Medical Center, Ben-Gurion University, Beer-Sheva, Israel.
Address correspondence and reprint requests to Hania Szajewska, MD, Department of Paediatrics, Medical University of Warsaw, 01-184 Warsaw, Dzialdowska 1, Poland (e-mail: email@example.com).
Received 14 January, 2014
Accepted 21 January, 2014
H.S. has participated as a clinical investigator, and/or advisory board member, and/or consultant, and/or speaker for Arla, Biogaia, Biocodex, Danone, Dicofarm, HiPP, Nestlé, Nestlé Nutrition Institute, Nutricia, Mead Johnson, Merck, and Sequoia. A.G. has participated in basic research supported by Biocodex and Dicofarm and in clinical trials and/or advisory boards and/or conference grant by Nutricia, Humana, Malesci, and Mead Johnson. I.H. has participated as a clinical investigator for Biogaia and Chr Hansen. F.I. has participated as a clinical investigator and/or consultant and/or speaker for Arla Food, Biogaia, Noos, Nestlé, and Nestlé Nutrition Institute. S.K. has participated as a clinical investigator, and/or speaker for Abbott, Arla, Biogaia, Chr Hansen, Danone, Dukat, Nestlé, Nutricia, and Merck-Sharpe-Dohme. R.S. has participated as a clinical investigator, and/or advisory board member, and/or consultant, and/or speaker for Abbott, Danone Institute International, Danone, Enzymotec, Nestlé, Nestlé Nutrition Institute, and Nutricia. Y.V. is a consultant for Biocodex and United Pharmaceuticals. Z.W. has participated as a clinical investigator, and/or consultant and/or speaker for BioCodex, BioGaia, HiPP, Materna, Mead Johnson, Nestlé, Nutricia, and Sensus.