Probiotics for preventing healthcare-associated diarrhea in children: A meta-analysis of randomized controlled trials

Abstract

AimTo systematically update evidence on the efficacy of using probiotics for the prevention of healthcare-associated diarrhea in children. MethodsMEDLINE, EMBASE, The Cochrane Library, Health Source: Nursing/Academic Edition, two clinical trials and reference lists were searched in June 2013, for randomized controlled trials (RCTs) performed in children aged 1 month to 18 years that compared the effects of the administration of probiotics with placebo or no intervention. The primary outcome measure was the incidence of healthcare-associated diarrhea. ResultsSix RCTs involving 1343 children met the inclusion criteria. Administration of Lactobacillus rhamnosus GG (LGG) compared with placebo reduced the risk of healthcare-associated diarrhea (2 RCTs, n=823, RR 0.37; 95% CI 0.23–0.59), reduced the risk of rotavirus gastroenteritis (3 RCTs, n=1043, RR 0.49, 95% CI 0.28–0.86), but did not reduce the risk of asymptomatic rotavirus infection (2 RCTs, n=301, RR 1.39, 95% CI 0.74–2.62). Administration of Bifidobacterium bifidum & Streptococcus thermophilus compared with placebo reduced the risk of healthcare-associated diarrhea (1 RCT, n=55, RR 0.22, 95% CI 0.05–0.96), rotavirus gastroenteritis (1 RCT, n=55, RR 0.27, 95% CI 0.08–0.87), and rotavirus asymptomatic infection (1 RCT, n=55, RR 0.27, 95% CI 0.08–0.87). Administration of two other probiotics (i.e., Lactobacillus reuteri DSM 17938 and Lactobacillus delbrueckii H2B20) was ineffective. ConclusionIn hospitalized children, the administration of LGG, compared with placebo, reduced the incidence of healthcare-associated diarrhea, including rotavirus diarrhea. Evidence on the effects of other probiotics, whether positive or negative, is limited.