Systematic review with meta-analysis: Lactobacillus rhamnosus GG for treating acute gastroenteritis in children - a 2019 update.

2019-04-25
Alimentary pharmacology & therapeutics 49(11)
- Hania Szajewska
- Maciej Kołodziej
- Dorota Gieruszczak-Białek
- Agata Skórka
- Marek Ruszczyński
- Raanan Shamir

PubMed: 31025399
DOI: 10.1111/apt.15267

Study Design

Type: Meta-Analysis
Sample size: n = 4,208
Population: children with acute gastroenteritis
Methods: Systematic review and meta-analysis of RCTs, searched Cochrane, MEDLINE, EMBASE from May 2013 to January 2019

Rigorous Journal

Background

Recently, evidence from a large randomised controlled trial (RCT) negated efficacy of Lactobacillus rhamnosus GG for treating acute gastroenteritis in children.

Aim

To review RCTs in which L rhamnosus GG was used to treat acute gastroenteritis in children.

Methods

The Cochrane Library, MEDLINE, and EMBASE databases were searched from May 2013 (end of last search) to January 2019. The primary outcomes were stool volume and duration of diarrhoea.

Results

Eighteen RCTs (n = 4208) were included. Compared with placebo or no treatment, L rhamnosus GG use had no effect on stool volume but was associated with a reduced duration of diarrhoea (15 RCTs, n = 3820, mean difference, MD -0.85 day, 95% CI -1.15 to -0.56). L rhamnosus GG was effective when used at a daily dose of ≥10¹⁰ CFU or <10¹⁰ CFU; however, the latter produced results of borderline significance. L rhamnosus GG was more effective when used in European countries compared with non-European countries, particularly when considered by region. L rhamnosus GG use was associated with a reduced duration of hospitalisation. One RCT found that L rhamnosus GG had no effect on the total clinical severity score at 14 days after enrolment.

Conclusions

Despite a recent large RCT demonstrating no effect of L rhamnosus GG, current evidence shows that, overall, L rhamnosus GG reduced both the duration of diarrhoea (with a higher impact in European countries) and hospitalisation in inpatients. These findings should be viewed in the context of the high heterogeneity and methodological limitations of the included trials.

Research Insights

Lactobacillus rhamnosus GG→Reduced Clinical Severity Score
One RCT found that L rhamnosus GG had no effect on the total clinical severity score at 14 days after enrolment.
Effect
Neutral
Effect size
Small
Lactobacillus rhamnosus GG→Reduced Diarrhea Rate
L rhamnosus GG use ... was associated with a reduced duration of diarrhoea (15 RCTs, n = 3820, mean difference, MD -0.85 day, 95% CI -1.15 to -0.56)
Effect
Beneficial
Effect size
Small
Lactobacillus rhamnosus GG→Reduced Hospitalization Duration
L rhamnosus GG use was associated with a reduced duration of hospitalisation.
Effect
Beneficial
Effect size
Small
Lactobacillus rhamnosus GG→Reduced Stool Volume
L rhamnosus GG use had no effect on stool volume
Effect
Neutral
Effect size
Small

Adverse Events Reported

Lactobacillus rhamnosus GG→Overall tolerability
These findings should be viewed in the context of the high heterogeneity and methodological limitations of the included trials.
Finding
Reported