Bacillus clausii for the Treatment of Acute Diarrhea in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Gianluca Ianiro,Giovanni Cammarota,Francesco Franceschi,Loris Lopetuso,Manuel Plomer,Franco Scaldaferri,Antonio Gasbarrini,Gianenrico Rizzatti

doi:10.3390/nu10081074

Abstract

Acute diarrhea is a burdensome disease with potentially harmful consequences, especially in childhood. Despite its large use in clinical practice, the efficacy of the probiotic Bacillus clausii in treating acute childhood diarrhea remains unclear. Our objective was to systematically review the efficacy of Bacillus clausii in the treatment of acute childhood diarrhea. The following electronic databases were systematically searched up to October 2017: MEDLINE (via PubMed/OVID), EMBASE (via OVID), Cochrane Central Database of Controlled Trials (via CENTRAL), Google Scholar, and ClinicalTrials.gov. Only randomized controlled trials were included. The overall effect for the meta-analysis was derived by using a random effects model. Six randomized controlled trials (1298 patients) met the eligibility criteria. Data arising from pooled analysis showed that Bacillus clausii significantly reduced the duration of diarrhea (mean difference = −9.12 h; 95% confidence interval [CI]: −16.49 to −1.75, p = 0.015), and the duration of hospitalization (mean difference = −0.85 days; 95% CI: −1.56 to −0.15, p = 0.017), compared with control. There was a trend of decreasing stool frequency after Bacillus clausii administration compared with the control group (mean difference = −0.19 diarrheal motions; 95% CI: −0.43 to −0.06, p = 0.14). Bacillus clausii may represent an effective therapeutic option in acute childhood diarrhea, with a good safety profile.

Highlights

Diarrhea refers to the abrupt onset of three or more loose or liquid stools per day [1]
We conducted a systematic review and a meta-analysis of randomized controlled trials to estimate the efficacy of Bacillus clausii in the treatment of acute diarrhea in children
Results of this systematic review indicate that Bacillus clausii combined with oral rehydration salts (ORS) might significantly reduce the duration of acute childhood diarrhea and the duration of hospital stay compared to ORS alone

Summary

Introduction

Diarrhea refers to the abrupt onset of three or more loose or liquid stools per day [1]. Acute diarrhea is defined as an abnormally frequent discharge of semi-solid or fluid fecal matter from the bowel, lasting less than 14 days [2]. It is a preventable disease, acute diarrhea remains a major cause of morbidity and mortality in children worldwide, resulting in 525,000 deaths per year among those younger than five years. Most of these mortalities occur in developing countries [1]. Acute diarrhea in children is caused by a wide range of pathogens—including viral, bacterial, and protozoal pathogens—which makes overcoming the high disease burden a large challenge [4]

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Conclusion