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Not All Probiotics Are Created Equal

Two of five probiotic preparations reduced the duration and severity of diarrhea in children.

Probiotics are used increasingly in the treatment of diarrheal illnesses. In a multisite, randomized, clinical trial conducted in Italy, 571 children (age range, 3–36 months) with acute diarrhea — who were otherwise well — received either oral rehydration solution (ORS) only or ORS followed by one of five probiotic preparations. Diarrhea was defined as three or more outputs of loose or liquid stools per day.

After receiving ORS for 3 to 6 hours, the children were fed formula containing lactose or cow’s milk. Each probiotic preparation was prescribed for 5 days and administered in 20 mL of water according to the manufacturers’ instructions. Beginning on the second day of treatment, two probiotic preparations were significantly better than the other three and than ORS alone in reducing the severity of diarrhea. Median duration of diarrhea also was significantly shorter for the two preparations. Median duration was 115.5 hours with ORS alone, 78.5 hours with Lactobacillus casei subsp rhamnosus GG, and 70.0 hours with a preparation containing four strains of bacteria. Duration of diarrhea was similar for the probiotics Saccharomyces boulardii (105.0 hours), Bacillus clausii (118.0 hours), and Enterococcus faecium SF68 (115.0 hours).

Comment: Not surprisingly, all probiotics are not created equal. Some probiotic preparations appear to be more active than others for treatment of diarrhea in young children. The composition and trade names for the products proven effective in this study, including Lactobacillus GG, may differ in the U.S. and Europe. The probiotic dose contained in these products seems to be equally important: The two effective preparations in this study had the greatest number of bacterial colony–forming units, a finding consistent with previous studies.

— Howard Bauchner, MD, and Cornelius W. Van Niel, MD

Published in Journal Watch Pediatrics and Adolescent Medicine September 19, 2007

Citation(s):

Canani RB et al. Probiotics for treatment of acute diarrhoea in children: Randomised clinical trial of five different preparations. BMJ 2007 Aug 18; 335:340.

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