Probiotics Found Unhelpful in Kids With Outpatient Diarrhea

Stephen Freedman MDCM, MSc Alberta Children's Hospital Foundation Professor in Child Health and Wellness Sections of Pediatric Emergency Medicine and Gastroenterology Alberta Children's Hospital & Research Institute University of Calgary Calgary, AB

Dr. Freedman Interview with:
Stephen Freedman MDCM, MSc
Alberta Children’s Hospital Foundation Professor in Child Health and Wellness
Sections of Pediatric Emergency Medicine and Gastroenterology
Alberta Children’s Hospital & Research Institute
University of Calgary
Calgary, AB What is the background for this study?

Response: Vomiting and diarrhea remain extremely common diseases in children and are the most common reason children are brought for emergency department care in North America.  While we have options to reduce vomiting there historically has been little physicians can offer to reduce the severity of the diarrhea.

Probiotics have recently emerged as an option with some early evidence of benefit in clinical trials but the studies performed to date have been small and few little research has been conducted in North America in outpatient or emergency department children.

The one study to date that was performed in a US emergency department did not find probiotic use to be beneficial.  Given the increasing importance of clarifying this issue we undertook this study. What are the main findings?

Response: We found that in children presenting to an emergency department with diarrhea secondary to an acute intestinal infection, twice-daily administration of a combination probiotic containing Lactobacillus rhamnosus and Lactobacilus helveticus did not prevent development of moderate-severe disease. When we conducted sub-group analyses, no beneficial groups were identified.  When we looked at individual symptoms, we also identified no benefits associated with probiotic administration. What should readers take away from your report?

Response: Strong evidence, as we expect for all medications, is required to support health benefit claims, before widespread adoption and endorsement for use should occur.

Specifically from this study we found no evidence to support probiotic use in outpatient children with diarrheal disease. What recommendations do you have for future research as a result of this work? 

Response: Ongoing research is needed to clarify how probiotics work in children with acute intestinal infection and this can lead to identifying which subgroups of children will benefit from a probiotic and the focus needs to be identifying specific beneficial probiotics along with their required  dose and duration of treatment. Is there anything else you would like to add?

Response: The study was funded by CIHR and we did receive study drug and placebo in-kind from Lallemand Health Solutions Inc.


Multicenter Trial of a Combination Probiotic for Children with Gastroenteritis

Stephen B. Freedman, M.D.C.M., Sarah Williamson-Urquhart, B.Sc.Kin., Ken J. Farion, M.D., Serge Gouin, M.D.C.M., Andrew R. Willan, Ph.D., Naveen Poonai, M.D., Katrina Hurley, M.D., Philip M. Sherman, M.D., Yaron Finkelstein, M.D., Bonita E. Lee, M.D., Xiao-Li Pang, Ph.D., Linda Chui, Ph.D.,  for the PERC PROGUT Trial Group*

November 22, 2018
N Engl J Med 2018; 379:2015-2026
DOI: 10.1056/NEJMoa1802597


Link to Commentary:

Probiotics for Children with Gastroenteritis
J. Thomas LaMont, M.D


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