Some Probiotics No Panacea for Childhood Diarrhea

NAPLES, Italy, Aug. 10 -- Not all probiotics stem acute childhood diarrhea any better than standard oral hydration, researchers here found.

A head-to-head comparison of five products containing different strains of beneficial gut-colonizing microorganisms showed that only two were more effective than oral rehydration, reported Alfredo Guarino, M.D., of the University of Naples Federico II here, and colleagues, online in BMJ.

A 2004 Cochrane review concluded that the mild therapeutic benefit of probiotics was similar across strains. But, Dr. Guarino and colleagues said, their findings suggest physicians and patients should focus on the individual microorganisms when choosing a commercial probiotic product.

"We believe that probiotic preparations should be classified as drugs, and physicians should select preparations for which evidence of efficacy, in a given clinical condition, is supported by solid data, they wrote. Probiotics are not regulated as drugs by the FDA.

Glucose-electrolyte oral rehydration solution is the time-honored management for acute diarrhea but has no impact on duration or severity of diarrhea, the investigators noted.

The search for agents to alter the course of diarrhea has ushered probiotics to the top of the list of commonly prescribed treatments for children with diarrhea in Italy.

But few probiotic efficacy trials have been properly controlled, the investigators said.

So they compared five of the most frequently used probiotics in Italy: Lactobacillus rhamnosus (L. casei strain GG); Bacillus clausii; Enterococcus faecium SF68; the yeast Saccharomyces boulardii; and a mix of L. delbrueckii var bulgaricus, Streptococcus thermophilus, L. acidophilus, and Bifidobacterium bifidum.

The prospective single blind trial randomized 571 children ages three to 36 months with acute diarrhea to be given a prescription to purchase one of these specific probiotic products along with oral rehydration or to receive oral rehydration only.

Baseline characteristics were similar among groups. The researchers said it was safe to assume that most of the children had viral acute gastroenteritis.

The children were to receive the probiotic preparations (sold only in pharmacies in Italy) for five days administered orally according to the manufacturers' instructions.

The researchers found that two of the probiotics came out ahead of the control on the primary endpoints.

The total duration of diarrhea was significantly lower with L. GG and the bacterial mix than oral rehydration alone (78.5 and 70.0 versus 115.5 hours, both P

"Not all commercially available probiotic preparations are effective in children with acute diarrhea," they concluded. "Pediatricians should choose bacterial preparations based on effectiveness data."