"Lactobacillus for Acute Gastroneteritis ... Doesn't Work"

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AllisS
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"Lactobacillus for Acute Gastroneteritis ... Doesn't Work"

Postby AllisS » Wed May 08, 2019 10:20 pm

I've reproduced the entire piece, below, because a link to it would work only if you're subscribed to the New England Journal of Medicine's "Journal Watch." Lactobacillus is most commonly known by its brandname, Culturelle. Though its efficacy was assessed for a condition other than C. diff, its failure may (or may not) portend a wider failure of probiotics. ~ Allison

May 7, 2019
Lactobacillus for Acute Gastroenteritis: Unfortunately, It Doesn't Work

Carolyn K. Holland, MD, MEd, FACEP, FAAP reviewing Szymański H and Szajewska H. Pediatr Infect Dis J 2019 Apr 25

Yet another randomized, controlled trial demonstrates lack of efficacy of probiotics for acute gastroenteritis in children.

In a randomized, controlled, double-blind trial, researchers in Poland evaluated the efficacy of the probiotic Lactobacillus reuteri for treatment of acute gastroenteritis (AGE) in young children. Ninety-one otherwise healthy patients <5 years old with presumed AGE (defined as change in stool consistency, frequency, or both)- received a daily dose of either Lactobacillus reuteri or placebo for 5 days. The primary outcome was time to resolution of diarrhea (back to normal stool consistency or normal number of daily stools) and normal stool for 48 hours. Secondary outcomes included need for intravenous fluids and duration of hospitalization.

The duration of diarrhea was similar in both groups. All secondary outcomes were also similar in both groups, except for duration of hospitalization, which was 6 hours shorter in the probiotic group (95% confidence interval: 0.1–17.7; P=0.048).
Comment

It seems logical that increasing the presence of “good” bacteria in gut flora should improve outcomes in gastroenteritis. Unfortunately, logic loses out to science in this case. This study confirms the findings of two much larger studies that demonstrated lack of effect of L. rhamnosus GG (alone and in combination with L. helveticus) in pediatric patients with AGE (NEJM JW Emerg Med Jan 2019 and N Engl J Med 2018; 379:2002 and 2015). Although the current study tested a different species of Lactobacillus, the only significant effect I can see these probiotics having is on the parents' wallets. A 6-hour decrease in hospital stay, while barely statistically significant, is not clinically significant. We should not be prescribing this as yet unproven (and somewhat disproven) therapy with the expectation that it will have any clinical benefit.
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