Systematic review with meta‐analysis: Lactobacillus rhamnosus GG for treating acute gastroenteritis in children – a 2019 update

Abstract

Background:Recently, evidence from a large randomised controlled trial (RCT) negated efficacy of Lactobacillus rhamnosus GG for treating acute gastroenteritis in children.Aim: To review RCTs in which L rhamnosus GG was used to treat acute gastroenteritis in children. Methods:The Cochrane Library, MEDLINE, and EMBASE databases were searched from May 2013 (end of last search) to January 2019. The primary outcomes were stool volume and duration of diarrhoea.Results: Eighteen RCTs (n = 4208) were included. Compared with placebo or no treatment, L rhamnosus GG use had no effect on stool volume but was associated with a reduced duration of diarrhoea (15 RCTs, n = 3820, mean difference, MD −0.85 day, 95% CI −1.15 to −0.56). L rhamnosus GG was effective when used at a daily dose of ≥10 10 CFU or <10 10 CFU; however, the latter produced results of borderline significance. L rhamnosus GG was more effective when used in European countries compared with non-European countries, particularly when considered by region.L rhamnosus GG use was associated with a reduced duration of hospitalisation. One RCT found that L rhamnosus GG had no effect on the total clinical severity score at 14 days after enrolment. Conclusions:Despite a recent large RCT demonstrating no effect of L rhamnosus GG, current evidence shows that, overall, L rhamnosus GG reduced both the duration of diarrhoea (with a higher impact in European countries) and hospitalisation in inpatients. These findings should be viewed in the context of the high heterogeneity and methodological limitations of the included trials. | 1377SZAJEWSKA Et Al.

Systematic review with meta‐analysis: Saccharomyces boulardii for treating acute gastroenteritis in children—a 2020 update

“…The timing of the initiation of probiotic administration is likely to contribute to the overall effect. At least this has been documented with regard to L rhamnosus GG, which was more effective when used in children enrolled with diarrhoea lasting ≤5 days than when used in children with diarrhoea lasting >7 days . For the purposes of this review, we performed a post hoc analysis based on the duration of diarrhoea prior to randomisation (≤72 h vs >72 h (or not specified).…”

“…The methodology was similar to one followed in our earlier systematic review on a similar topic . The protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) on 30 September 2019 (ID: 152 832); however, formal registration was still pending at the time of the writing of this manuscript.…”

“…The methodology was similar to one followed in our earlier systematic review on a similar topic. 12 The protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) on 30 September 2019 (ID: 152 832); however, formal registration was still pending at the time of the writing of this manuscript. The guidelines from the Cochrane Collaboration for undertaking and reporting the results of a systematic review and meta-analysis 13 and the PRISMA statement 14 were followed for this systematic review and meta-analysis.…”

Oral Mutian®X stopped faecal feline coronavirus shedding by naturally infected cats

“…FeIFNω has previously been shown to reduce, but not stop, FCoV shedding (Gil et al, 2013). Probiotics are routinely used to treat children with viral diarrhoea (Szajewska et al, 2019), but the interaction of the gut microbiome and FCoV has not been extensively explored (Meazzi et al, 2019): further investigation into the possibility that probiotics might reduce coronavirus load is warranted.…”

Editorial: Lactobacillus GG for diarrhoea in children—reports of its demise have been premature!

“…The updated systematic review and meta‐analysis by Szajewska and colleagues is a timely and welcome re‐appraisal of the topic . The authors limit their analysis to a single probiotic strain, and therefore eliminate one of the many sources of heterogeneity that bedevil comparisons of probiotic studies in this or any indication.…”