Several probiotic products are marketed as effective treatments for acute diarrhoea in children, but a study published on bmj.com today finds that not all of these preparations are effective.
Probiotics are defined as micro-organisms that exert beneficial effects on human health when they colonise the bowel.
Researchers at the University of Naples tested five different preparations in 571 children with acute diarrhoea. All the children were aged 3-36 months and were visiting a family paediatrician with acute diarrhoea. Children were randomly assigned to receive either a specific probiotic product for five days (intervention groups) or oral rehydration solution (control group).
At the time of the study, these products were among the most widely used probiotic preparations in Italy, they were available only in pharmacies and had a similar brand image and price.
Duration of diarrhoea and daily number and consistency of stools were monitored as primary outcomes. Secondary outcomes were duration of vomiting and fever and rate of admission to hospital. Safety and tolerance were also recorded.
Duration of diarrhoea was significantly lower in children receiving Lactobacillus GG and a mix of four bacterial strains than in patients receiving oral rehydration alone. The three other preparations had no significant effect.
Secondary outcomes were similar in all groups and no side effects were recorded.
These results suggest that not all commercially available probiotic preparations are effective in children with acute diarrhoea, say the authors.
The effectiveness of Lactobacillus GG was not unexpected as several previous studies have shown similar results. The other effective preparation contained four bacterial species, two of which have also been shown to protect against diarrhoea in chronically sick children.
However, the lack of effect in children receiving Saccharomyces boulardii was unexpected, they say, because a previous trial showed it to be beneficial in young children admitted to hospital for diarrhoea.
They conclude: the efficacy of probiotic preparations for the treatment of acute diarrhoea in children is related to the individual strains of bacteria, and physicians should choose preparations based on effectiveness data.