Page 154 - 15Diarrhoeaandvomiting

Other therapies

Evidence summary

There was evidence from a well-conducted systematic review examining the effectiveness of
probiotics compared with control in the treatment of acute diarrhoea in children. The review
showed that children receiving a probiotic had a reduction in the duration of diarrhoea and in
the stool frequency. However, there was evidence of significant statistical heterogeneity and
there was variation across the included studies regarding the specific probiotic employed, the
therapeutic regimen used, the methodology and the population included.

8.5.2 Lactobacillus rhamnosus GG
One systematic review 197 evaluated the effectiveness of Lactobacillus rhamnosus GG in the
treatment of acute infectious diarrhoea in children. This well-conducted systematic review
included eight RCTs involving 988 participants, 494 in the intervention group and 494 in the
control group. Of the eight studies, four were located in European countries, three in South
America and one in Pakistan. Participants were children aged between 1 and 36 months with
acute diarrhoea, and were inpatients as well as outpatients. They presented with different grades
of dehydration and duration of diarrhoea prior to enrolment. However, in most of the trials,
participants were mildly dehydrated and had diarrhoea for less than 3 days prior to inclusion in
the studies. The trial conducted in Pakistan included undernourished children. Definition criteria
for diarrhoeal resolution, rehydration protocols administered and doses of the study medication
varied across the studies. The methodology and conduct of the eight RCTs was heterogeneous:
method of randomisation and allocation concealment were unclear or inadequate in four and
six studies, respectively, two trials were not blinded and three trials did not include an intention-
to-treat analysis. In one study, 43% of the participants enrolled did not complete the follow-up.
Data were extracted and meta-analysis was performed for the following outcomes: duration of
diarrhoea, diarrhoea on day 3, stool output and hospitalisation. In addition, the review looked at
vomiting and treatment failure. [EL = 1+]
Seven trials measured the duration of diarrhoea (n = 876). The authors of the review performed
a meta-analysis (high heterogeneity, with I² = 97.4%) showing that children receiving the
Lactobacillus rhamnosus GG, compared with children in the control group, experienced
a statistically significant reduction of 1 day in the duration of the diarrhoeic episode
(WMD −1.08 days; 95% CI −1.87 to −0.28 days) (Figure 8.11).
Three trials reported the duration of rotavirus diarrhoea in children (n = 201). The data were
pooled, despite high heterogeneity (I² = 94%), showing that children in the intervention
group had a statistically significantly shorter duration of diarrhoea than those children in the
control group (WMD −2.08 days; 95% CI −3.55 to −0.60 days). Two RCTs (n = 303) showed
no statistically significant difference between the children treated with the probiotic and the
children in the control group. The results of three studies were combined (I² = 86.4%) to show
that the mean hospital stay was not statistically significantly different among children receiving
the Lactobacillus rhamnosus GG and the control group. One trial (n = 36) measured the number
of emetic episodes on day 1 of the study and on day 2. The trial found no statistically significant
difference between the two groups in the frequency of vomiting on day 1. On day 2, the difference

Figure 8.11 Comparison of the effect of Lactobacillus rhamnosus GG versus placebo on the duration of diarrhoea

129