Use of Probiotics for the Management of Acute Gastroenteritis in Children. An Update

Since the publication of the 2014 ESPGHAN Working Group (WG) on Probiotics & Prebiotics guidelines on probiotics for management of acute gastroenteritis (AGE), new evidence concerning the efficacy of probiotics has become available. This document provides updated recommendations on the use of probiotics for the treatment of AGE in previously presumed healthy infants and children. A systematic literature search was performed. All pooled analyses were explicitly performed for the current report. The WG graded the recommendations and assessed the certainty of the supporting evidence using the Grading of Recommendations, Assessment Development, and Evaluations (GRADE) tool. The recommendations were formulated if at least two randomized controlled trials (RCTs) that used a given probiotic were available. Despite the large number of identified trials, the WG could not identify two RCTs of high quality for any strain that provided benefit when used for treating AGE. The WG made weak recommendations for (in descending order in terms of the number of trials evaluating any given strain): Saccharomyces boulardii (low to very low certainty of evidence); Lactobacillus rhamnosus GG (very low certainty of evidence); L reuteri DSM 17938 (low to very low certainty of evidence); and L rhamnosus 19070-2 & L reuteri DSM 12246 (very low certainty of evidence). The WG made a strong recommendation against L helveticus R0052 & L rhamnosus R0011 (moderate certainty of evidence) and a weak recommendation against Bacillus clausii strains O/C, SIN, N/R, and T (very low certainty of evidence).