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Cited by 87Probiotics and Fermented FoodsInfant Nutrition and HealthChild Nutrition and Water Access

Systematic review of probiotics for the treatment of community-acquired acute diarrhea in children

Open access
Applegate, Jennifer A, Fischer Walker, Christa L, Ambikapathi, Ramya, Black, Robert E·2013·BMC Public Health
DOI 10.1186/1471-2458-13-s3-s16PMC PMC3847198
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Abstract

BACKGROUND: Oral rehydration salts (ORS), zinc, and continued feeding are the recommended treatments for community-acquired acute diarrhea among young children. However, probiotics are becoming increasingly popular treatments for diarrhea in some countries. We sought to estimate the effect of probiotics on diarrhea morbidity and mortality in children < 5 years of age. METHODS: We conducted a systematic review of randomized controlled trials to estimate the effect of probiotic microorganisms for the treatment of community-acquired acute diarrhea in children. Data were abstracted into a standardized table and study quality was assessed using the Child Health Epidemiology Reference Group (CHERG) adaption of the GRADE technique. We measured the relative effect of probiotic treatment in addition to recommended rehydration on hospitalizations, duration and severity. We then calculated the average percent difference for all continuous outcomes and performed a meta-analysis for discrete outcomes. RESULTS: We identified 8 studies for inclusion in the final database. No studies reported diarrhea mortality and overall the evidence was low to moderate quality. Probiotics reduced diarrhea duration by 14.0% (95% CI: 3.8-24.2%) and stool frequency on the second day of treatment by 13.1% (95% CI: 0.8 - 25.3%). There was no effect on the risk of diarrhea hospitalizations. CONCLUSION: Probiotics may be efficacious in reducing diarrhea duration and stool frequency during a diarrhea episode. However, only few studies have been conducted in low-income countries and none used zinc (the current recommendation) thus additional research is needed to understand the effect of probiotics as adjunct therapy for diarrhea among children in developing countries.

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  • Recent systematic reviews have not identified a specific probiotic preparation for use in clinical practice.

    “However, in spite of this increased evidence base, recent systematic reviews have not identified a specific probiotic preparation for use in clinical practice.”

    From Probiotics for treating acute infectious diarrhoea (2020) · cites this paper as Applegate 2013

  • In children from middle- and high-income countries, probiotics reduced diarrhoea duration by 14% (95% CI 3.8% to 24.2%).

    “In children from middle‐ and high‐income countries, probiotics reduced diarrhoea duration by 14% (95% CI 3.8% to 24.2%) and stool frequency on day two by 13.1% (95% CI 0.8% to 25.3%; Applegate 2013).”

    From Probiotics for treating acute infectious diarrhoea (2020) · cites this paper as Applegate 2013

  • In both meta-analyses, evidence was insufficient to support a specific strain or regimen.

    “In both meta‐analyses, evidence was insufficient to support a specific strain or regimen.”

    From Probiotics for treating acute infectious diarrhoea (2020) · cites this paper as Applegate 2013

  • In children from middle- and high-income countries, probiotics reduced stool frequency on day two by 13.1% (95% CI 0.8% to 25.3%).

    “In children from middle‐ and high‐income countries, probiotics reduced diarrhoea duration by 14% (95% CI 3.8% to 24.2%) and stool frequency on day two by 13.1% (95% CI 0.8% to 25.3%; Applegate 2013).”

    From Probiotics for treating acute infectious diarrhoea (2020) · cites this paper as Applegate 2013

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Authors
Applegate, J. A., Fischer Walker, C. L., Ambikapathi, R., & Black, R. E.
Affiliations
Johns Hopkins University (US)
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2013-09
Volume
13
Issue
S3
Pages
S16-S16
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/1471-2458-13-s3-s16
PMC
PMC3847198
OpenAlex
W2162653556
Cited by
87
References
22
Citations by year
2026: 2 · 2025: 4 · 2024: 4 · 2023: 4 · 2022: 4 · 2021: 7 · 2020: 9 · 2019: 10 · 2018: 6 · 2017: 15 · 2016: 9 · 2015: 10 · 2014: 3
FWCI
0.97
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
Johns Hopkins University
Topics
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
  • Health Sciences › Nursing › Nutrition and Dietetics › Infant Nutrition and Health
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
Keywords
probiotics, acute diarrhea, community-acquired diarrhea, children, diarrhea duration, stool frequency, oral rehydration salts, zinc supplementation, adjunctive therapy, low-income countries
MeSH terms
Acute Disease, Child, Child, Preschool, Combined Modality Therapy, Developing Countries, Diarrhea, Female, Fluid Therapy, Humans, Infant, Male, Poverty, Trace Elements, Zinc, Rehydration Solutions, Community-Acquired Infections, Probiotics

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