Pathogenic Effects of Probiotics in Children With Acute Gastroenteritis

Among children with acute gastroenteritis, probiotic treatment with either combination Lactobacillus rhamnosus and L helveticus or L rhamnosus GG alone did not result in a decreased risk for severe disease compared with placebo, according to results of a study published in Clinical Infectious Diseases.

A team of researchers analyzed patient-level data from 2 multicenter randomized, placebo-controlled trials performed in pediatric emergency departments in Canada and the United States. The trials included patients with acute gastroenteritis who were aged 3 to 48 months and had greater than 3 diarrheal episodes in the past 24 hours. In addition, patients had to be symptomatic for less than 72 hours and less than 7 days to be eligible for the Canadian trial and US trial, respectively. Patients were randomly assigned in a 1:1 fashion; those included in the Canadian trial were treated with either a probiotic combination of L rhamnosus and L helveticus or placebo, and those in the US trial were treated with either L rhamnosus GG or placebo. The primary outcome was the development of moderate-to-severe gastroenteritis, defined as a score of equal to or greater than 9 on the Modified Vesikari Scale (MVS) stratified by pathogen group and individual pathogens.

Among a total of 1857 participants who were enrolled, 1565 (84.3%) completed follow-up and provided a specimen for enteropathogen analysis. Enteropathogens were identified in specimens from 928 (59.3%) children, with the most common being norovirus (23.2%), followed by rotavirus (21.0%), and adenovirus (10.4%). Among patients with either of these pathogens, the researchers found no differences in regard to the likelihood of experiencing an MVS score equal to or greater than 9 based on treatment allocation (test for interaction=0.35). In addition, there were no identifiable differences among patients with adenovirus (adjusted relative risk [aRR], 1.42; 95% CI, 0.62-3.23), norovirus (aRR, 0.98; 95% CI, 0.56, 1.74), rotavirus (aRR, 0.86; 95% CI, 0.43-1.71), or those with bacterial enteropathogens (aRR, 1.19; 95% CI, 0.41-3.43).

The researchers noted that the risk for moderate-to-severe acute gastroenteritis was decreased among only patients with no identifiable pathogens who received L rhamnosus GG (aRR, 0.56; 95% CI, 0.35-0.90). Also, patients infected with adenovirus who received combination treatment with L rhamnosus/L helveticus experienced fewer diarrheal episodes (aRR, 0.65; 95% CI, 0.47-0.90).

The study was limited because it was a secondary analysis of studies that evaluated 2 different probiotic treatments. Further limitations were limited generalizability, the possibility that a subset of study patients may not have had a noninfectious etiology for their diarrhea, and potential selection bias.

According to the researchers, “the preponderance of the evidence does not support the notion that there are pathogen-specific benefits associated with probiotic use in children with [acute gastroenteritis].”

Disclosure: One author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Freedman SB, Finkelstein Y, Pang X-L, et al. Pathogen-specific effects of probiotics in children with acute gastroenteritis seeking emergency care: A randomized trial. Clin Infect Dis. Published online October 1, 2021. doi: 10.1093/cid/ciab876