Lactobacillus Therapy for Acute Infectious Diarrhea in Children: A Meta-analysis (original) (raw)
Review Article| April 01 2002
Cornelius W. Van Niel, MD
*Sea Mar Community Health Center, Seattle, Washington
‡Department of Pediatrics, University of Washington, Seattle, Washington
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Chris Feudtner, MD, PhD, MPH
‡Department of Pediatrics, University of Washington, Seattle, Washington
§Child Health Institute, University of Washington, Seattle, Washington
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Michelle M. Garrison, MPH
§Child Health Institute, University of Washington, Seattle, Washington
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Dimitri A. Christakis, MD, MPH
Dimitri A. Christakis, MD, MPH
‡Department of Pediatrics, University of Washington, Seattle, Washington
§Child Health Institute, University of Washington, Seattle, Washington
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Reprint requests to (C.W.V.N.) Sea Mar Community Health Center, 8720 14th Ave South, Seattle, WA 98108. E-mail: [email protected]
Pediatrics (2002) 109 (4): 678–684.
Objective. Childhood diarrhea accounts for substantial morbidity and mortality worldwide. Multiple studies in children have shown that Lactobacillus, administered orally, may have antidiarrheal properties. We conducted a meta-analysis of randomized, controlled studies to assess whether treatment with Lactobacillus improves clinical outcomes in children with acute infectious diarrhea.
Methods. Studies were sought in bibliographic databases of traditional biomedical as well as complementary and alternative medicine literature published from 1966 to 2000. Search terms were “competitive inhibition,” “diarrhea,” “gastroenteritis,” “Lactobacillus,” “probiotic,” “rotavirus,” and “yog(h)urt.” We included studies that were adequately randomized, blinded, controlled trials in which the treatment group received Lactobacillus and the control group received an adequate placebo and that reported clinical outcome measures of diarrhea intensity. These inclusion criteria were applied by blind review and consensus. The original search yielded 26 studies, 9 of which met the criteria. Multiple observers independently extracted study characteristics and clinical outcomes. Data sufficient to perform meta-analysis of the effect of Lactobacillus on diarrhea duration and diarrhea frequency on day 2 were contained in 7 and 3 of the included studies, respectively.
Results. Summary point estimates indicate a reduction in diarrhea duration of 0.7 days (95% confidence interval: 0.3–1.2 days) and a reduction in diarrhea frequency of 1.6 stools on day 2 of treatment (95% confidence interval: 0.7–2.6 fewer stools) in the participants who received Lactobacillus compared with those who received placebo. Details of treatment protocols varied among the studies. A preplanned subanalysis suggests a dose-effect relationship.
Conclusion. The results of this meta-analysis suggest that Lactobacillus is safe and effective as a treatment for children with acute infectious diarrhea.
Copyright © 2002 by the American Academy of Pediatrics
2002
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Comments
1 Comment
Live versus killed Lactobacilllus
February 3 2003
Maurice Vanbellinghen
The autors state : "We did not find (...) that the effect of Lactobacillus on diarrhea duration was modified by (...) live versus killed Lactobacillus preparation". From this I infer that the authors suppose that killed Lactobacillus- bacteria are or can be as effective as live Lactobacillus-bacteria. Yet, in Table 1 (Included Studies)I see only 1 study having used killed L. acidophilus (Simakachorn et al.) Furthermore, is it methodologically correct to include in a meta-analysis such differents products? Killed bacteria are not live bacteria, I would say. Seems a bit strange to me. And how can one then conclude, on the basis of only 1 study, that killed bacteria could be effective in reducing the duration of diarrhea in children?
Submitted on February 03 2003
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