Probiotics May Not Affect Symptom Duration in Pediatric Acute Gastroenteritis

Investigators assessed the efficacy of probiotics based on duration of symptoms and frequency of diarrhea at the time of treatment initiation in pediatric patients with acute gastroenteritis.

Among children aged 3 to 48 months with acute gastroenteritis, administering probiotics to pediatric patients presenting to the emergency department may not prevent moderate to severe gastroenteritis, regardless of the duration or frequency of diarrhea prior to presentation, according to study findings published in The American Journal of Gastroenterology.

Probiotics are often used for the treatment of acute gastroenteritis in children. Moreover, it is believed that treatment is more effective if started earlier and in more severe cases; however, recent studies have questioned the evidence that supports the use of probiotics in these patients.

A team of investigators conducted a preplanned, secondary analysis of 2 randomized placebo-controlled trials to assess the efficacy of probiotics based on duration of symptoms and frequency of diarrhea at the time of treatment initiation in pediatric patients aged 3 to 48 months with acute gastroenteritis.

The probiotics included were Lactobacillus rhamnosus GG and combination Lactobacillus rhamnosus with Lactobacillus helveticus. Patients were categorized based on duration (<24, 24 to <72, and ≥72 hours) and number of episodes of diarrhea within the 24 hours before presentation (≤3, 4-5, and ≥6 episodes). The primary outcome was moderate to severe gastroenteritis, which was defined by a total postenrollment Modified Vesikari Scale (MVS) score of 9 or greater in the 14-day follow-up interval. Secondary outcomes were frequency and duration of diarrhea, unscheduled visits to health care providers, and hospitalization.

Of the 1770 children (median age, 16 months; 55.1% boys) included in the analysis, 882 patients received probiotic treatment. In the 24 hours preceding enrollment, there was a median of 5 diarrheal episodes and 76.4% of patients vomited during this time; 58.7% of patients had severe diarrhea (6 or more episodes in the 24 hours preceding enrollment) and 59.7% of patients had diarrhea durations 24 to 72 hours before presentation.

Compared with patients in the placebo cohort (n=888), patients in the probiotic cohort had similar MVS scores of 9 or greater after enrollment (18.3% in the placebo group vs 18.4% in the probiotic group; unadjusted relative risk, 1.00; P =.95). Results based on severity group were still not statistically significant (P =.61).

Secondary outcomes were also not significant between cohorts for unscheduled health care provider visits (P =.96), hospitalizations (P =.87), diarrhea duration (P =.88), or maximum diarrheal episodes (P =.87).

The investigators acknowledge their analysis of studies that utilized 2 different types of probiotics is not ideal, as it limits the ability to distinguish strain-specific effects. 

“These results clarify that diarrhea duration and frequency before initiating probiotic therapy are not associated with the presence or absence of beneficial effects in the study population,” the authors concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Schnadower D, O’Connell KJ, VanBuren JM, et al for the Pediatric Emergency Care Applied Research Network and Pediatric Emergency Research Canada. Association between diarrhea duration and severity and probiotic efficacy in children with acute gastroenteritis. Am J Gastroenterol. 2021;116(7):1523-1532. doi:10.14309/ajg.0000000000001295