Utility of Probiotics in Gastroenteritis Treatment in the Paediatric Population

Background: Acute gastroenteritis is the sudden onset of diarrhoea with passage of 3 or more loose stools in a 24 hour period, or the passage of 1 or more bloody stools in the presence or absence of abdominal pain, fever, nausea and vomiting. Acute gastroenteritis is self-limiting lasting 2 weeks or less, however, it is a major cause of morbidity and mortality worldwide. Current primary treatment is restoration of the acid-base balance, correction of electrolyte disturbances, and oral rehydration. The treatment helps to decrease morbidity and mortality, however, it seldom impacts the duration and symptoms of the infection. Probiotics may help reduce both the duration and severity of symptoms of gastroenteritis, however strain specific efficacy and inter-strain comparison has yet to be established.

Objective: This systematic review examines original research and the different strains of probiotics used to determine the efficacy of probiotics in treating acute gastroenteritis in the paediatric population.

Methods: An Embase search was carried out and the articles were screend by two reviewers. All reviewer conflicts were resolved by a third reviewer. Data was extracted from the included articles to determine correlation and effects of probiotics.

Results: 581 results obtained from the search. 11 studies were included for data extraction after applying the inclusion and exclusion criteria. Majority of the studies showed probiotics reduced duration of diarrhoea (8 of 11 studies), and duration of hospitalisation (6 of 11 studies). 2 papers reported adverse effects, such as fungaemia, in immunocompromised and ICU patients. The different strains of probiotics that were examined in the selected papers include Saccharomyces boulardii, Lactobacillus casei, and Lactobacillus acidophilus.

Conclusion; Probiotics reduced the duration of diarrhoea symptoms and hospitalization. Usage of probiotics was however accompanied by minimal side effects but not indicated in immunocompromised patients with gastroenteritis. Further research needs to be conducted to determine the strain specific efficacy and dosage requirements for treatment of gastroenteritis using large scale double blinded RCTs.