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This article is part of the supplement: The Lives Saved Tool in 2013: new capabilities and applications

Open Access Review

Systematic review of probiotics for the treatment of community-acquired acute diarrhea in children

Jennifer A Applegate, Christa L Fischer Walker*, Ramya Ambikapathi and Robert E Black

Author Affiliations

Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA

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BMC Public Health 2013, 13(Suppl 3):S16  doi:10.1186/1471-2458-13-S3-S16

Published: 17 September 2013

Abstract

Background

Oral rehydration salts (ORS), zinc, and continued feeding are the recommended treatments for community-acquired acute diarrhea among young children. However, probiotics are becoming increasingly popular treatments for diarrhea in some countries. We sought to estimate the effect of probiotics on diarrhea morbidity and mortality in children < 5 years of age.

Methods

We conducted a systematic review of randomized controlled trials to estimate the effect of probiotic microorganisms for the treatment of community-acquired acute diarrhea in children. Data were abstracted into a standardized table and study quality was assessed using the Child Health Epidemiology Reference Group (CHERG) adaption of the GRADE technique. We measured the relative effect of probiotic treatment in addition to recommended rehydration on hospitalizations, duration and severity. We then calculated the average percent difference for all continuous outcomes and performed a meta-analysis for discrete outcomes.

Results

We identified 8 studies for inclusion in the final database. No studies reported diarrhea mortality and overall the evidence was low to moderate quality. Probiotics reduced diarrhea duration by 14.0% (95% CI: 3.8-24.2%) and stool frequency on the second day of treatment by 13.1% (95% CI: 0.8 – 25.3%). There was no effect on the risk of diarrhea hospitalizations.

Conclusion

Probiotics may be efficacious in reducing diarrhea duration and stool frequency during a diarrhea episode. However, only few studies have been conducted in low-income countries and none used zinc (the current recommendation) thus additional research is needed to understand the effect of probiotics as adjunct therapy for diarrhea among children in developing countries.