Page 153 - 15Diarrhoeaandvomiting

Diarrhoea and vomiting caused by gastroenteritis in children under 5 years

Data from 13 studies were pooled in a meta-analysis. The relative risk of diarrhoea lasting 4 or more
days in the group treated with probiotics when compared with the control group was 0.31 (95% CI
0.19 to 0.50). However, there was heterogeneity between studies (I² = 72.9%). A meta-analysis
pooling together the data from the nine RCTs that recruited children (n = 895) showed that more
of those receiving placebo (168/436) had persistence of diarrhoea on day 4 or beyond compared
with those receiving probiotics (79/459) (RR 0.26; 95% CI 0.13 to 0.52; I² = 62%) (Figure 8.9).
The mean duration of diarrhoea was measured in 12 studies that included only children. Those
children receiving the probiotic agent had a statistically significantly shorter duration of diarrhoea
when compared with the children in the control group (WMD −30.5 hours; 95% CI −42.5 to
−18.5 hours; random effects model; I² = 85.6%) (Figure 8.10).
The mean stool frequency on day 2 was reported in five trials (n = 417) and on day 3 it was
reported in four trials (n = 447). Participants in the probiotic group had statistically significantly
fewer stools on day 2 of intervention (WMD −1.51; 95% CI −1.85 to −1.17) and on day 3 of
intervention (WMD −1.31; 95% CI −1.56 to −1.07). Data extracted for the stool frequency from
the studies that recruited children were included in a meta-analysis. The analysis showed that
on day 2 (four RCTS, n = 232), children treated with probiotics passed statistically significantly
fewer stools than those receiving placebo (WMD −1.01; 95% CI −1.66 to −0.36). On day 3 of
intervention (two RCTs, n = 170), children in the probiotic group passed statistically significantly
fewer stools than children in the control group (WMD −1.12; 95% CI −1.79 to −0.46). The
review reported that occasionally children developed severe dehydration requiring parenteral
fluid therapy but in none of the studies was this attributable to the administration of the probiotic
agent causing an adverse event. No death events were recorded among the included studies.

Figure 8.9 Comparison of the effect of probiotics versus placebo on diarrhoea (persistence of diarrhoea on day 4)

Figure 8.10 Comparison of the effect of probiotics versus placebo on the duration of diarrhoea

128