Probiotics for preventing healthcare-associated diarrhea in children: A meta-analysis of randomized controlled trials

Abstract Aim To systematically update evidence on the efficacy of using probiotics for the prevention of healthcare-associated diarrhea in children. Methods MEDLINE, EMBASE, The Cochrane Library, Health Source: Nursing/Academic Edition, two clinical trials and reference lists were searched in June 2013, for randomized controlled trials (RCTs) performed in children aged 1 month to 18 years that compared the effects of the administration of probiotics with placebo or no intervention. The primary outcome measure was the incidence of healthcare-associated diarrhea. Results Six RCTs involving 1343 children met the inclusion criteria. Administration of Lactobacillus rhamnosus GG (LGG) compared with placebo reduced the risk of healthcare-associated diarrhea (2 RCTs, n  = 823, RR 0.37; 95% CI 0.23–0.59), reduced the risk of rotavirus gastroenteritis (3 RCTs, n  = 1043, RR 0.49, 95% CI 0.28–0.86), but did not reduce the risk of asymptomatic rotavirus infection (2 RCTs, n  = 301, RR 1.39, 95% CI 0.74–2.62). Administration of Bifidobacterium bifidum & Streptococcus thermophilus compared with placebo reduced the risk of healthcare-associated diarrhea (1 RCT, n  = 55, RR 0.22, 95% CI 0.05–0.96), rotavirus gastroenteritis (1 RCT, n  = 55, RR 0.27, 95% CI 0.08–0.87), and rotavirus asymptomatic infection (1 RCT, n  = 55, RR 0.27, 95% CI 0.08–0.87). Administration of two other probiotics ( i.e. , Lactobacillus reuteri DSM 17938 and Lactobacillus delbrueckii H2B20) was ineffective. Conclusion In hospitalized children, the administration of LGG, compared with placebo, reduced the incidence of healthcare-associated diarrhea, including rotavirus diarrhea. Evidence on the effects of other probiotics, whether positive or negative, is limited.