A Systematic Review and Meta-Analysis: Lactobacillus acidophilus for Treating Acute Gastroenteritis in Children.

Haixin Cheng,Xiaohui Liu,Yi Ma,Xuli Zhong,Chao Tian,Libo Zhao

doi:10.3390/nu14030682

Abstract

The efficacy of probiotic strains of Lactobacillus acidophilus to manage acute gastroenteritis in children is still not established. We searched the Cochrane Library, PubMed, EMBASE, and three Chinese literature databases (CNKI, WanFang, and CBM) from their inception to February 2021 for RCTs that compared the use of Lactobacillus acidophilus with no Lactobacillus acidophilus. The grey literature was searched through Google Scholar. Authors of the original papers were contacted for additional data. The study included a total of 15 RCTs involving 1765 patients. Compared with placebo or no treatment, Lactobacillus acidophilus was associated with a reduced duration of diarrhea (moderate quality of evidence), but the effect was not statistically significant when only the individual probiotic strain was provided. Lactobacillus acidophilus was effective when used at a daily dose ≥ 109 CFU. There was no difference in the effect of Lactobacillus acidophilus on diarrhea duration among Asian, European, or American countries. Lactobacillus acidophilus reduced the frequency of diarrhea on day 2 to day 5. However, it was statistically significant on day 3. When administered at a dosage of more than 109 CFU to children with acute gastroenteritis, moderate- to low-quality data showed that Lactobacillus acidophilus reduced the duration of diarrhea and conferred a benefit for frequency of diarrhea.

Highlights

For children under the age of five, acute gastroenteritis ranks second on the list of main causes of mortality in the world [1]
The purpose of this study was to assess the effectiveness of Lactobacillus acidophilus supplementation for treating children with acute gastroenteritis, and to give suggestions on probiotic treatments for acute gastroenteritis in children according to the assessment result
To children with acute gastroenteritis, whether the probiotic strains are used in combination or alone

Summary

Introduction

For children under the age of five, acute gastroenteritis (a clinical illness characterized by increased stool frequency, accompanied with or without vomiting, fever, or stomach discomfort) ranks second on the list of main causes of mortality in the world [1]. Despite a 90 percent reduction in diarrhea-related mortality over the previous forty years, acute gastroenteritis continues to be a serious public health concern. The European Evidence-Based Guidelines for managing acute gastroenteritis in children concluded that heat-killed Lactobacillus acidophilus LB (low quality of evidence, weak recommendation) demonstrated some efficacy in reducing acute gastroenteritis-related symptoms in pediatric age groups [3]. 5.0 [4]; in consequence, it can reach the small intestine (pH < 7), and is able to thrive in the small intestine rather than the colon (pH > 7). Possible mechanisms for the therapeutic effects of Lactobacillus acidophilus include amelioration of the impairment of electrolyte absorption [5], maintenance of immunological homeostasis [6], antibiotic activity/antiviral activity [7], and promotion of intestinal epithelial integrity [8]. In 2018, a network meta-analysis of randomized and quasi-randomized trials found high-quality evidence that combinations of Lactobacillus acidophilus and other probiotic strains could reduce the duration of diarrhea by approximately one day

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