The Role of Probiotics in Pediatric Gastroenteritis

Author:
Jessica Tomaszewski, MD

Citation:
Tomaszewski J. The role of probiotics in pediatric gastroenteritis [published online January 18, 2019]. Gastroenterology Consultant.

Schnadower D, Tarr PI, Casper TC, et al. Lactobacillus rhamnosus GG versus placebo for acute gastroenteritis in children. N Engl J Med. 2018;379(21):2002-2014.

Acute gastroenteritis is incredibly common, resulting in approximately 1.7 million estimated US pediatric emergency department (ED) visits.¹ It also leads to significant nonmedical burdens, such as lost earnings for caregivers. Current management for this condition is primarily supportive, particularly with respect to dehydration, but probiotics are a commonly used adjunct therapy.

While some literature exists supporting the use of probiotics in the treatment of gastroenteritis, there had been no sufficiently powered, randomized controlled trials to determine their efficacy. Dr Schnadower and his colleagues described the Pediatric Emergency Care Applied Research Network (PECARN) probiotic trial, which examined the use of Lactobacillus rhamnosus GG, a commonly recommended and used probiotic in the setting of acute gastroenteritis.

This prospective, randomized, double-blind trial involved children aged 3 months to 4 years with acute gastroenteritis who presented to one of 10 geographically diverse university-affiliated pediatric EDs. Participants received 5 days of either L rhamnosus GG or placebo. Follow-up surveys were conducted at 5 days, 14 days, and 1 month. Outcomes measured included severity of illness, duration and frequency of diarrhea and vomiting, duration of missed days of day care, and household transmission.

The study enrolled 971 participants, 943 of whom completed the trial. No significant difference was identified between the probiotic or placebo groups in the severity of illness, duration of diarrhea, duration of vomiting, missed days of day care, or household transmission. The percentage of participants who received anti-nausea medication or antibiotics after randomization was similar between groups.

The findings in this large, well-designed study indicate that the commonly used probiotic L rhamnosus GG may not have a role in the treatment of acute gastroenteritis. The response to probiotics appears to be fairly individualized, with factors such as epigenetics and indigenous microbiota, which are hard to factor into a large study such as this. Many other strains of probiotics are commercially available and may still have a role in the treatment of acute gastroenteritis. While this is a low-risk intervention, it does not seem like an effective treatment option at the moment until more is known about the other commercially available strains. 

Reference:

1. Freedman SB, Steiner MJ, Chan KJ. Oral ondansetron administration in emergency departments to children with gastroenteritis: an economic analysis. PLoS Med. 2010;7(10):e1000350-e1000350.