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Effect of Limosilactobacillus reuteri DSM17938 to prevent antibiotic-associated diarrhea in children: prospective, multi-center, randomized, placebo-controlled clinical trial (PEARL Study).

  • 2025-06-09
  • European journal of pediatrics 184(7)
    • Ener Cagri Dinleyici
    • Metehan Ozen
    • Sirin Guven
    • Nazan Dalgic
    • Adem Karbuz
    • Murat Sutcu
    • Ozden Turel
    • Fatma Nur Oz
    • Ulviye Kirli
    • Sevgi Yasar Durmus
    • Ahmet Sami Yazar
    • Zeynep Ebru Cakin
    • Yvan Vandenplas
    • Ates Kara

Study Design

Type
Randomized Controlled Trial (RCT)
Sample size
n = 330
Population
outpatient children with acute otitis media (AOM) or acute rhinosinusitis (ARS) in Türkiye between 2017-2019
Methods
prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial; Group 1 received amoxicillin-clavulanate and L. reuteri DSM 17938 (2×10^8 CFU) and Group 2 received amoxicillin-clavulanate and a placebo during the antibiotic treatment or continued for 21 days after antibiotic cessation
Blinding
Double-blind
Duration
during the antibiotic treatment or continued for 21 days after antibiotic cessation; follow-up at 14, 21, and 56 days
  • Large Human Trial
Antibiotic-associated diarrhea (AAD) is one of the side effects that occur during and after antibiotic use. Some probiotics have strain-specific beneficial effects on AAD development when used in combination with antibiotics. The aim of this study was to evaluate the effect of Limosilactobacillus reuteri DSM 17938 on the prevention of AAD in children. This is a prospective, multicenter, randomized, double-blind, placebo-controlled clinical trial in Türkiye between 2017-2019, among outpatient children with acute otitis media (AOM) or acute rhinosinusitis (ARS). Group 1 (n = 330) received amoxicillin-clavulanate and L. reuteri DSM 17938 (2 × 108 CFU) and Group 2 (n = 324) received amoxicillin-clavulanate and a placebo during the antibiotic treatment or continued for 21 days after antibiotic cessation. The primary end point of this study was the percentage of children with AAD in the first 14, 21, and 56 days of follow-up. Secondary endpoints are the percentage of children with AAD regarding the AOM vs ARS, amoxicillin-clavulanate dose, age groups, and the comparison between 14- and 21-days use of L. reuteri. The percentage of children with AAD was significantly lower in the L. reuteri group compared to the placebo group at 14 days (7.9% vs. 16.7%; RR: 0.47, 95%CI 0.30-0.7; p < 0.001); at 21 days (8.8% vs. 17.9%; RR: 0.49, 95%CI 0.32-0.74;p < 0.001); and at 56 days (9.1% vs. 19.6%; RR: 0.46, 95%CI 0.30-0.69;p < 0.001). The incidence of AAD was also significantly lower in the L. reuteri group at 14, 21 and 56 days among children aged between 6-24 months (p < 0.01, p < 0.01, p < 0.001) or children with AOM (p = 0.0001,p < 0.0001,p < 0.0001). When AAD was observed, the mean duration of diarrhea was longer in the placebo group(p < 0.05).

Conclusions

This first study with L. reuteri DSM 17938 in a large pediatric outpatient setting showed significant reduction of AAD during the first 14 days of antibiotic use and the 8-week follow-up period.

Trial registration

NCT02765217 (First Submitted 02.05.2016) ( https://clinicaltrials.gov/study/NCT02765217?term=NCT02765217&rank=1 ).

What is known

• Antibiotic associated diarrhea (AAD) is one of the common complications of antibiotic use in children and selected probiotics may have a strain-specific effect to prevent AAD • There are limited studies about the effects of Limosilactobacillus reuteri DSM 17938 on AAD, and no study available in pediatric outpatient setting.

What is new

• Limosilactobacillus reuteri DSM 17938 significantly reduced the incidence of AAD in children at 14-, 21-, and 56- days follow-up. • The effect is mainly observed in children aged between 6 and 24 months or children with AOM.

Research Insights

  • Lactobacillus reuteri DSM 17938→Reduced Antibiotic-Associated Diarrhea

    The percentage of children with AAD was significantly lower in the L. reuteri group compared to the placebo group at 14 days (7.9% vs. 16.7%; RR: 0.47, 95%CI 0.30-0.7; p < 0.001); at 21 days (8.8% vs. 17.9%; RR: 0.49, 95%CI 0.32-0.74;p < 0.001); and at 56 days (9.1% vs. 19.6%; RR: 0.46, 95%CI 0.30-0.69;p < 0.001).

    Effect
    Beneficial
    Effect size
    Large
    Dose
    2 × 10^8 CFU
  • Lactobacillus reuteri DSM 17938→Reduced Duration of Diarrhea

    When AAD was observed, the mean duration of diarrhea was longer in the placebo group(p < 0.05).

    Effect
    Beneficial
    Effect size
    Small
    Dose
    2 × 10^8 CFU

Adverse Events Reported

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