Efficacy of Lactobacillus rhamnosus GG in treatment of acute pediatric diarrhea: A systematic review with meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 31543689 · doi:10.3748/wjg.v25.i33.4999
What was done
A systematic review and meta-analysis of randomized controlled trials (RCTs) searched EMBASE, MEDLINE, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials up to April 2019. The authors evaluated the efficacy of Lactobacillus rhamnosus GG ATCC 53013 (LGG) in treating acute pediatric diarrhea. Relevant data were synthesized using Cochrane Review Manager.
What was found
Nineteen RCTs were included. Overall, LGG significantly reduced diarrhea duration compared to controls (mean difference [MD] -24.02 h, 95% CI -36.58 to -11.45). Reductions were observed with high-dose therapy ≥ 10^10 CFU/day (MD -22.56 h, 95% CI -36.41 to -8.72) versus lower doses. Diarrhea duration was similarly reduced in Asian (MD -24.42 h, 95% CI -47.01 to -1.82) and European cohorts (MD -32.02 h, 95% CI -49.26 to -14.79). In participants treated within 3 days of diarrhea onset, duration was reduced (MD -15.83 h, 95% CI -20.68 to -10.98). For rotavirus-induced diarrhea, high-dose LGG reduced duration (MD -31.05 h, 95% CI -50.31 to -11.80) and stool frequency per day (MD -1.08, 95% CI -1.87 to -0.28).
Why it matters
This meta-analysis supports the clinical utility of high-dose LGG in shortening acute pediatric diarrhea episodes by roughly one day, particularly when initiated early in the disease course.
Limits
The total number of enrolled children and study-level risk of bias were not reported in the abstract. Several subgroup analyses exhibited wide confidence intervals, indicating heterogeneity or imprecision, and the abstract notes that recent RCTs have shown conflicting neutral results.
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