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Systematic review: Limosilactobacillus reuteri DSM 17938 for preventing antibiotic-associated diarrhoea in children.

  • 2026-01-04
  • Journal of pediatric gastroenterology and nutrition 82(3)
    • Hania Szajewska
    • Maciej Kołodziej
    • Bartłomiej M Zalewski
    • Ener Cagri Dinleyici
    • Jan Łukasik

Study Design

Type
Systematic Review
Sample size
n = 998
Population
children receiving systemic antibiotics
Methods
Systematic review and meta-analysis of randomized controlled trials comparing L. reuteri DSM 17938 with placebo, no treatment, or other probiotics in children

Objectives

Probiotic effects are strain-specific; each strain needs to be assessed individually. In this review, we evaluated the effectiveness of Limosilactobacillus reuteri DSM 17938 in preventing antibiotic-associated diarrhoea (AAD) in children receiving systemic antibiotics.

Methods

We searched the Cochrane Library, MEDLINE, EMBASE and trial registries (January 2016-July 2025) for randomized controlled trials (RCTs) comparing L. reuteri DSM 17938 with placebo, no treatment, or other probiotics in children. Risk of bias was assessed with Risk of Bias 2 (ROB-2), and certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

Results

Three RCTs (1070 randomized, 998 analysed) were included. No significant effect was observed with ≤14-day administration (two RCTs, n = 901; risk ratio [RR] 0.85, 95% confidence interval low certainty evidence), with interpretation limited by heterogeneity (I2 = 91%) and analytical differences. A regimen of up to 21 days reduced AAD risk (two RCTs, n = 751; RR: 0.50, 95% CI: 0.33-0.75; moderate certainty evidence). A post hoc analysis of trials with follow-up up to 56 days showed no significant effect (three RCTs, n = 998; RR: 0.85, 95% CI: 0.29-2.46; I2 = 83%). A subgroup analysis limited to children receiving amoxicillin-clavulanate showed benefit (two RCTs, n = 690; RR: 0.49, 95% CI: 0.32-0.76; I2 = 0%).

Conclusions

L. reuteri DSM 17938 may reduce the risk of AAD in children when administered for up to 21 days or in those receiving amoxicillin-clavulanate. No benefit was found with shorter administration or extended follow-up. Further high-quality trials are needed before routine use can be recommended.

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