Use of probiotics for management of acute gastroenteritis: A position paper by the ESPGHAN working group for probiotics and prebiotics

Hania Szajewska, Alfredo Guarino, Iva Hojsak, Flavia Indrio, Sanja Kolacek, Raanan Shamir, Yvan Vandenplas, Zvi Weizman

Research output: Contribution to journalArticlepeer-review

158 Scopus citations

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.

Original languageEnglish
Pages (from-to)531-539
Number of pages9
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume58
Issue number4
DOIs
StatePublished - 1 Jan 2014

Keywords

  • RCT
  • diarrhea
  • guideline
  • infants
  • microbiota
  • probiotics
  • systematic review

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