Probiotics Do Not Improve the Outcomes in Pediatric Acute Gastroenteritis

Introduction

Acute gastroenteritis affects millions of children in the U.S. every year, leading to emergency department visits and hospitalizations. Probiotics, particularly Lactobacillus rhamnosus GG (LGG), have been commonly used as a treatment, but evidence supporting their effectiveness has been limited [1-3]. A new study conducted by the Pediatric Emergency Care Applied Research Network (PECARN) aimed to determine whether LGG could reduce the severity of gastroenteritis in children. The trial found that LGG did not significantly improve outcomes compared to placebo [4].

Study question

Does administering Lactobacillus rhamnosus GG to children with acute gastroenteritis reduce the incidence of moderate-to-severe disease compared to placebo?

Study design

This randomized, double-blind, placebo-controlled trial included 971 children between the ages of 3 months and 4 years who presented to 10 U.S. emergency departments. The children received either LGG or a placebo for five days, and their symptoms were monitored for two weeks.

Results

The study found no significant difference between the LGG and placebo groups in terms of moderate-to-severe gastroenteritis (11.8% vs. 12.6%, respectively). There were also no differences in the duration of diarrhea or vomiting, day-care absenteeism, or household transmission of symptoms.

Caution

While this study provides important insights, it is worth noting that probiotics may still play a role in other health contexts. However, for pediatric gastroenteritis, the evidence suggests they do not provide significant benefits.

Video Short: Principal Investigator Dr. Schnadower Insight

Take home messages

  1. Lactobacillus rhamnosus GG does not reduce the severity or duration of gastroenteritis symptoms in children.
  2. Caregivers should prioritize hydration and symptomatic care over probiotics for managing gastroenteritis.
  3. The findings may shift the approach to treating pediatric gastroenteritis in both clinical and home settings.

Why is this important for patients and caregivers

Parents often use probiotics, like Lactobacillus rhamnosus GG, hoping to reduce the severity of their child’s gastroenteritis. However, this large study shows that probiotics do not significantly shorten illness duration, improve symptoms, or reduce the need for additional medical visits. By using the latest research, parents can focus on more effective treatments like hydration.

  1. The study clarifies that probiotics, particularly LGG, may not be as beneficial as previously thought for treating acute gastroenteritis in children.

  2. This can help caregivers make informed decisions about the use of probiotics during their child’s illness.

  3. Reducing unnecessary treatments can also reduce medical costs and the burden of administering non-beneficial interventions.

References

  1. Freedman SB, Williamson-Urquhart S, Farion KJ, et al. Multicenter Trial of a Combination Probiotic for Children with Gastroenteritis. N Engl J Med. 2018;379(21):2015-2026. doi:10.1056/NEJMoa1802597. PMID 30462939
  2. Parker MW, Schaffzin JK, Lo Vecchio A, et al. Rapid adoption of Lactobacillus rhamnosus GG for acute gastroenteritis. Pediatrics. 2013;131 Suppl 1(Suppl 1):S96-S102. doi:10.1542/peds.2012-1427l. PMID 23457156
  3. Szajewska H, Skórka A, Ruszczyński M, Gieruszczak-Białek D. Meta-analysis: Lactobacillus GG for treating acute gastroenteritis in children–updated analysis of randomised controlled trials. Aliment Pharmacol Ther. 2013;38(5):467-476. doi:10.1111/apt.12403. PMID 23841880
  4. Schnadower D, Tarr PI, Casper TC, et al. Lactobacillus rhamnosus GG versus Placebo for Acute Gastroenteritis in Children. N Engl J Med. 2018 Nov 22;379(21):2002-2014. doi: 10.1056/NEJMoa1802598. PMID: 30462938
Brad Sobolewski, MD, MEd

Brad Sobolewski, MD, MEd

Cincinnati Children's Hospital

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