Probiotic Ineffective for Acute Gastroenteritis in Preschool Children

The commonly used probiotic Lactobacillus rhamnosus GG does not improve outcomes in preschool-aged children with acute gastroenteritis compared with placebo, according to results from the Pediatric Emergency Care Applied Research Network (PECARN) probiotic trial.

Currently, no treatments are available for pediatric acute gastroenteritis. The lack of options has encouraged some physicians and parents to turn to probiotics to treat children.

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Further, no randomized controlled trials have been performed to support probiotic use in this patient population.

In their study, Schnadower and colleagues randomly assigned 971 children aged 3 years to 48 months to either 1x10¹⁰ colony forming units of Lactobacillus rhamnosus GG (n=468)—also known over the counter as Culturelle—twice daily or a placebo (n=475) for 5 days. 

A daily follow-up survey was administered for 5 days and then again at 14 days and 1 month after enrollment. Of all the participants, 943 completed the study follow-up.

Overall, 11.8% of participants in the probiotic group and 12.6% of the participants in the placebo group had moderate-to-severe gastroenteritis at the end of the study.

No significant differences in median duration of diarrhea (49.7 hours vs 50.9 hours), vomiting (0 hours for both), daycare absenteeism (2 days for both), or household transmission rates (10.6% vs 14.1%) were seen between the two groups.

“We tested many different scenarios—infants compared with toddlers, whether the patient had taken antibiotics, whether the gastroenteritis was caused by virus or bacteria, and how long the diarrhea had been going on before the treatment was given,” Dr David Schnadower said in an institution-issued press release. “We also had the probiotic independently tested for purity and strength. Every time, we reached the same conclusion: Lactobacillus rhamnosus GG did not help.”

—Colleen Murphy

References:
Schnadower D, Tarr PI, Casper TC, et al. Lactobacillus rhamnosus GG versus placebo for the treatment of acute gastroenteritis in children presenting to emergency departments: the PECARN probiotic trial. [published online November 21, 2018]. N Engl J Med. https://www.nejm.org/doi/full/10.1056/NEJMoa1802598. 

Probiotics no help to young kids with stomach virus. [press release]. St. Louis, MO: Washington University; November 21, 2018. Accessed November 20, 2018.