Systematic review with meta-analysis: Lactobacillus rhamnosus GG for treating acute gastroenteritis in children - a 2019 update.

Abstract

Recently, evidence from a large randomised controlled trial (RCT) negated efficacy of Lactobacillus rhamnosus GG for treating acute gastroenteritis in children. To review RCTs in which Lrhamnosus GG was used to treat acute gastroenteritis in children. The Cochrane Library, MEDLINE, and EMBASE databases were searched from May 2013 (end of last search) to January 2019. The primary outcomes were stool volume and duration of diarrhoea. Eighteen RCTs (n=4208) were included. Compared with placebo or no treatment, Lrhamnosus GG use had no effect on stool volume but was associated with a reduced duration of diarrhoea (15 RCTs, n=3820, mean difference, MD -0.85day, 95% CI -1.15 to -0.56). Lrhamnosus GG was effective when used at a daily dose of ≥1010 CFU or <1010 CFU; however, the latter produced results of borderline significance. Lrhamnosus GG was more effective when used in European countries compared with non-European countries, particularly when considered by region. Lrhamnosus GG use was associated with a reduced duration of hospitalisation. One RCT found that Lrhamnosus GG had no effect on the total clinical severity score at 14days after enrolment. Despite a recent large RCT demonstrating no effect of Lrhamnosus GG, current evidence shows that, overall, Lrhamnosus GG reduced both the duration of diarrhoea (with a higher impact in European countries) and hospitalisation in inpatients. These findings should be viewed in the context of the high heterogeneity and methodological limitations of the included trials.